Predictors of Delayed Hyponatraemia After Surgery for Pituitary
                    Tumour

Remya Rajan; Ari George Chacko; Shivendra Verma; Nitin Kapoor; Thomas Paul; Nihal Thomas; Felix Jebasingh; Kripa Elizabeth Cherian; Shalini Sahu; Asha Hesarghatta Shyamasunder

doi:10.1055/a-2074-9329

Hormone and Metabolic Research, Inhaltsverzeichnis

Horm Metab Res 2023; 55(06): 395-401
DOI: 10.1055/a-2074-9329

Original Article: Endocrine Care

Predictors of Delayed Hyponatraemia After Surgery for Pituitary Tumour

Authors

Remya Rajan

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India
Ari George Chacko

²Department of Neurosciences, Christian Medical College and Hospital Vellore, Vellore, India
Shivendra Verma

³Endocrinology, GSVM Superspeciality Post Graduate Institute, Kanpur, India
Nitin Kapoor

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India
Thomas Paul

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India
Nihal Thomas

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India
Felix Jebasingh

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India
Kripa Elizabeth Cherian

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India
Shalini Sahu

⁴Radiology, Christian Medical College and Hospital Vellore, Vellore, India
Asha Hesarghatta Shyamasunder

¹Endocrinology, Christian Medical College and Hospital Vellore, Vellore, India

Abstract

Delayed hyponatraemia(DH) is a common complication following trans-sphenoidal surgery(TSS) for pituitary tumour. We evaluated the prevalence of DH following TSS, and assessed the factors associated with DH, including early post-operative diabetes insipidus(EPDI). This retrospective study included 100 TSS for pituitary tumours in 98 patients, over a period of 26 months. Subjects were divided into two groups: those who developed hyponatraemia and those who did not develop hyponatraemia, during post-operative days 4 to 14. The clinical characteristics and peri-operative parameters were compared between the two groups, to identify factors predicting DH. The mean age of the patients was 42.0±13.6 years, 58 (59%) were females and 61 (61%) had functional tumours. Thirty-six patients(36%) developed DH following TSS of whom majority(58%) were diagnosed on post-operative days 7 and 8; only 8/36 (22%) were symptomatic. Syndrome of inappropriate antidiuretic hormone secretion(SIADH) was found to be the most common aetiology of DH. On logistic regression analysis, intra-operative cerebrospinal fluid(CSF) leak (OR 5.0; 95% CI 1.9–13.8; p=0.002), EPDI (OR 3.4; 95% CI 1.3–9.2; p=0.015) and peri-operative steroid use (OR 3.6; 95% CI 1.3–9.8; p=0.014) were found to be significantly associated with DH. In conclusion, EPDI, intra-operative CSF leak and peri-operative steroid use were significant predictors of DH. EPDI predicts moderate to severe hyponatraemia with 80% specificity but has low sensitivity(47%). As most patients have asymptomatic hyponatraemia, serum sodium measurement on POD 7 to 10 would be helpful to identify DH in patients at increased risk.

Key words

hyponatraemia - post-operative diabetes insipidus - SIADH - cerebrospinal fluid leak - pituitary tumour

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Referenzen

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