Postoperative Rise in Serum Sodium Level, an Indicator of Diabetes Insipidus after Pituitary Adenoma Surgery
Keywords:
Diabetes Insipidus, Pituitary Adenoma,, Postoperative Sodium Level Increase, transsphenoidal surgery, hypernatremia, hyponatremia, hypotonic polyuria, polydypsiaAbstract
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.
References
2. Pascual JM, Prieto R, Castro-Dufourny I, Carrasco R, Strauss S, Barrios L. Development of intracranial app-roaches for craniopharyngiomas: an analysis of the first 160 historical procedures. Neurosurgical focus, 2014 Apr; 36 (4): E13
Thomas JG, Gadgil N, Samson SL, Takashima M, Yo-shor D. Prospective trial of a short hospital stay proto-col after endoscopic endonasal pituitary adenoma sur-gery. World neurosurgery, 2014 Apr. 30; 81 (3): 576-83.
4. Nelson RW. Water metabolism and diabetes insipidus. InCanine and Feline Endocrinology: Fourth Edition 2014 Dec. 18. Elsevier Inc..
5. Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study. Saudi journal of anaesthesia, 2014 Jul; 8 (3): 335.
6. Pratheesh R, Swallow DM, Rajaratnam S, Jacob KS, Chacko G, Joseph M, Chacko AG. Incidence, predic-tors and early post-operative course of diabetes insipi-dus in paediatric craniopharygioma: a comparison with adults. Child's Nervous System, 2013 Jun. 1; 29 (6): 941-9.
7. Shah S, Har-El G. Diabetes insipidus after pituitary surgery: incidence after traditional versus endoscopic transsphenoidal approaches. American journal of rhino-logy, 2001 Nov. 1; 15 (6): 377-9.
8. Verbalis JG. Diabetes Insipidus: Principles of Diagno-sis and Treatment. In 2016 Meet-The-Professor: Endo-crine Case Management, 2016 (pp. 195-201). The Endocrine Society.
Timper K, Fenske WK, Katan M, Kuehn F, Arici B,Frech N, Rutishauser J, Kopp P, Allolio B, Stettler C, Mueller B. Copeptin in the Diagnosis and Differential Diagnosis of Diabetes Insipidus-the ‘Cosip-Study'. In Prolactin and Vasopressin: Genes to Receptor Signaling in Physiology and Disease, 2014 Jun (pp. OR35-6). Endocrine Society.
Schreckinger M, Walker B, Knepper J, Hornyak M, Hong D, Kim JM, Folbe A, Guthikonda M, Mittal S, Szerlip NJ. Post-operative diabetes insipidus after endo-scopic transsphenoidal surgery. Pituitary, 2013 Dec. 1; 16 (4): 445-51.
11. Kristof RA, Rother M, Neuloh G, Klingmüller D. Inci-dence, clinical manifestations, and course of water and electrolyte metabolism disturbances following trans-sphenoidal pituitary adenoma surgery: a prospective observational study. Journal of neurosurgery, 2009 Sep; 111 (3): 555-62.
12. Black PM, Zervas NT, Candia GL. Incidence and man-agement of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery, 1987 Jun. 1; 20 (6): 920-4. 13.
Patil CG, Lad SP, Harsh GR, Laws Jr ER, Boakye M. National trends, complications, and outcomes following transsphenoidal surgery for Cushing's disease from 1993 to 2002. Neurosurgical focus, 2007 Sep; 23 (3): 1-6.
Hensen J, Henig A, Fahlbusch R, Meyer M, BoehnertM, Buchfelder M. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pitu-itary adenomas. Clinical endocrinology, 1999 Apr. 1; 50 (4): 431-9.
15. Kristof RA, Rother M, Neuloh G, Klingmüller D. Inci-dence, clinical manifestations, and course of water and electrolyte metabolism disturbances following trans-sphenoidal pituitary adenoma surgery: a prospective observational study. Journal of neurosurgery, 2009 Sep; 111 (3): 555-62.
16. Hannon MJ, Finucane FM, Sherlock M, Agha A, Tho-mpson CJ. Disorders of water homeostasis in neuro-surgical patients. The Journal of Clinical Endocrinology & Metabolism, 2012 Feb. 22; 97 (5): 1423-33.
17. Ausiello JC, Bruce JN, Freda PU. Postoperative assess-ment of the patient after transsphenoidal pituitary sur-gery. Pituitary, 2008 Dec. 1; 11 (4): 391-401.
18. Dumont AS, Nemergut EC, Jane Jr JA, Laws Jr ER. Postoperative care following pituitary surgery. Journal of intensive care Medicine, 2005 May; 20 (3): 127-40.
19. Mamelak AN, Carmichael J, Bonert VH, Cooper O, Melmed S. Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary, 2013 Sep. 1; 16 (3): 393-401.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
