Postoperative Rise in Serum Sodium Level, an Indicator of Diabetes Insipidus after Pituitary Adenoma Surgery

  • NOOR-UL-HUDA MARIA Department of Neurosurgery, Lahore General Hospital/ Punjab Institute of Neurosciences/ Postgraduate Medical Institute/Ameerudin Medical College, Lahore
  • QURRAT -UL-AIN Department of Neurosurgery and Neurology, Lahore General Hospital Lahore/Punjab Institute of Neurosciences/Postgraduate Medical Institute/Ameerudin Medical College, Lahore
  • MUHAMMED ANWAR CHAUDARY Department of Neurosurgery and Neurology, Lahore General Hospital Lahore/Punjab Institute of Neurosciences/Postgraduate Medical Institute/Ameerudin Medical College, Lahore
Keywords: Diabetes Insipidus, Pituitary Adenoma,, Postoperative Sodium Level Increase, transsphenoidal surgery, hypernatremia, hyponatremia, hypotonic polyuria, polydypsia

Abstract

Objective: To study the efficacy of post operative rise in serum sodium level as indicator of diabetes insipidus after pituitary adenoma surgery.
Materials and Methods: The study was randomized control trial. It was conducted in Department of Neuro-surgery and Biochemistry from March 2016 to December 2017 (22 Months) Punjab Institute of Neurosciences/ Lahore General Hospital/Postgraduate Medical Institute/Ameeruddin Medical College. Ethical approval was obtained from hospital Ethics Committee. Total no. of 169 patients were enrolled for transsphenoidal surgery of their pituitary adenoma. Sample size was calculated from the reference study conducted by Schreckinger M et al10. Non probability consecutive sampling technique was used to collect the sample size. Data was calculated from all the patients regarding age, gender, duration of transsphenoidal surgery, postoperative evidence of diabetes insipidus by measuring rise in serum sodium level < 145mEq. Mean and standard deviation were calculated for demographic variables like age and gender while frequency and percentage were calculated for outcome variables like type of diabetes insipidus and sensitivity and specificity of serum sodium > 145mEq test. Chi square test was applied and analysis was done using computer software SPSS version 23. P value less than 0.05 was considered significant.
Results: Overall, 100% (n = 169) patients were enrolled in this study, both genders. Gender distribution showed there were 68% (n = 115) males and 32% (n = 54) females. The mean age of the patients was 40.88 ± 4.95 years. Post-operative transient noted in 13.6% (n = 23) patients. Serum sodium level (specific) observed in 92.9% (n = 157) patients. While, > 145 mEq sensitive was observed in 88.2% (n = 149) patients (Table 1). The main outcome variable of this study was diabetes insipidus permanent, in our study, it was noted in 9.5% (n = 16) patients (Table 2). There was no association between diabetes insipidus permanent and effect modifiers (Table 3).
Conclusion: From this study we conclude that level of sodium > 145mEq is very sensitive and specific test which can be used to predict the outcome after pituitary adenoma surgery in the form of Diabetes Insipidus.

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Published
2018-09-15
Section
Original Articles