Management of sodium metabolism derangements in children treated for hypothalamic-hypophyseal tumors

Abstract

Hyponatremia and hypernatremia, common electrolyte abnormalities in children hospitalized for intracranial diseases, are life-threatening events. Diagnosis and adequate treatment of hypo- and hypernatremia are mandatory to prevent neurological sequelae. We report ante-and post-hypophyseal dysfunctions, disabilities and acute sodium metabolism derangements in 16 children affected by hypothalamic-hypophyseal tumors treated by neurosurgery and/or chemotherapy during a long-lasting follow-up. We compare acute hypo- and hypernatremic episodes during surgery between these patients, treated with a specific hormonal and infusive protocol (protocol A), and a previous cohort of patients, affected by similar tumors, treated with a previously published protocol (protocol B). All patients showed multiple or isolated pituitary dysfunctions and disabilities before chemotherapy and/or surgical treatment that worsened during the follow-up period. We found a statistical significant decrease of hyponatremic intra-operative acute events in children treated with protocol A. Sodium metabolism derangements complicating the course of hypothalamic-hypophyseal tumors can be partially prevented with specific per-operative protocols. Aim of this study is to present a new sodium metabolism derangements management in children treated for hypothalamic-hypophyseal tumors and to compare this with a previous one.

Keywords

Sodium metabolism derangements - diabetes insipidus - SIADH - children - hypothalamic-hypophyseal tumors