A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery

Burke, William; Coté, David J.; Iuliano, Sherry; Zaidi, Hasan A.; Laws, Edward R.

doi:10.1007/s11102-017-0843-5

Cited by 79 publications

(50 citation statements)

References 36 publications

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“…At our institution, a high-volume neurosurgical department of a university hospital, we perform more than 200 pituitary procedures in a standardized fashion annually. The around 25% incidence of hyponatremia following pituitary surgery found in our study represents the upper limit of data from the literature, mostly because of the tight postoperative inpatient surveillance of our patients not waiting for symptoms and requiring readmission [ 16 , 28 ]. Secondly, the threshold for intervention based on the level of hyponatremia varies among authors and most start at a serum sodium of 125-129 mmol/L (64.5%) [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of hyponatremia in general is not ideal [ 3 , 4 ], as documented by different guidelines established in the United States [ 5 ] and in Europe [ 6 ]. In pituitary surgery, 1 L of free water restriction is used for the prevention of hospital readmission due to SIADH [ 28 ], and complies with general recommendations that are mainly symptomatic and consist of fluid restriction [ 26 , 27 ]. Only a minority of neurosurgeons use vaptans (7%) [ 30 ], although AVP receptor antagonists have been assessed in a literature review on neurosurgical and neurological adults [ 35 ], as well as in patients after Cushing disease surgery [ 29 ] and transsphenoidal pituitary surgery [ 16 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Current treatment recommendations for the management of hyponatremia are based on the differentiation of acute and chronic hyponatremia, the underlying etiology, and the existence of symptoms [ 5 ], while historically treatment was targeted at relief of symptoms and consisted of fluid restriction [ 26 , 27 ]. In a single-center study, following pituitary surgery, a universal 1 L per day of fluid restriction for 1 week postoperatively was used quite successfully to prevent hospital readmission due to hyponatremia following early discharge [ 28 ]. However, AVP receptor antagonists (vaptans) have been assessed to treat SIADH after surgery for Cushing disease [ 29 ].…”

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confidence: 99%

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Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery

Kleindienst

Georgiev

Schlaffer

et al. 2020

Journal of the Endocrine Society

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Context The relevance of hyponatremia has been acknowledged by guidelines from the United States (2013) and Europe (2014). However, treatment recommendations differ due to limited evidence. Objective In hyponatremia following pituitary surgery—caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion—we compared fluid restriction with the pharmacological increase of water excretion by blocking the vasopressin 2 receptors with tolvaptan at a low and a moderate dose. Design Prospective observational study. Setting Neurosurgical Department of a University hospital with more than 200 surgical pituitary procedures per year. Patients Patients undergoing pituitary surgery and developing serum sodium below 136 mmol/L. The diagnosis of SIADH was established by euvolemia (daily measurement of body weight and fluid balance), inappropriately concentrated urine (specific gravity), and exclusion of adrenocorticotropic and thyroid-stimulating hormone deficiency. Intervention Patients were treated with fluid restriction (n = 40) or tolvaptan at 3.75 (n = 38) or 7.5 mg (n = 48). Main Outcome Measures Treatment efficacy was assessed by the duration of hyponatremia, sodium nadir, and length of hospitalization. Safety was established by a sodium increment below 10 mmol/L per day and exclusion of side effects. Results Treatment with 7.5 mg of tolvaptan resulted in a significant attenuation of hyponatremia and in a significant overcorrection of serum sodium in 30% of patients. The duration of hospitalization did not differ between treatment groups. Conclusions Tolvaptan at a moderate dose is more effective than fluid restriction in the treatment of SIADH. Overcorrection of serum sodium may be a side effect of tolvaptan even at low doses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery

Kleindienst

Georgiev

Schlaffer

et al. 2020

Journal of the Endocrine Society

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“…SIADH may occur within the first 3–7 days postoperatively, with an incidence ranging from 4 to 20% [75]. Transient SIADH is due to iatrogenic manipulation of the posterior pituitary gland resulting in excessive antidiuretic hormone (ADH) release [76, 77].…”

Section: Introductionmentioning

confidence: 99%

“…Transient SIADH is due to iatrogenic manipulation of the posterior pituitary gland resulting in excessive antidiuretic hormone (ADH) release [76, 77]. In rare cases, it may result in severe, life-threatening, acute hyponatremia [75].…”

Section: Introductionmentioning

confidence: 99%

Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management

et al. 2019

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Purpose Non-functioning pituitary adenomas (NFPAs) are associated with impaired well-being, increased comorbidities, and reduced long-term survival. Data on optimal management of NFPAs around surgical treatment are scarce, and postoperative treatment and follow-up strategies have not been evaluated in prospective trials. Here, we review the preoperative, perioperative, and early postoperative management of patients with NFPAs. Methods We searched Medline and the Cochrane Library for articles published in English with the following items “Pituitary neoplasms AND Surgery” and “Surgery AND Hypopituitarism”. Studies containing detailed analyses of the management of NFPAs in adult patients, including pituitary surgery, endocrine care, imaging, ophthalmologic assessment and long-term outcome were reviewed. Results Treatment options for NFPAs include active surveillance, surgical resection, and radiotherapy. Pituitary surgery is currently recommended as first-line treatment in patients with visual impairment due to adenomas compressing the optic nerves or chiasma. Radiotherapy is reserved for large tumor remnants or tumor recurrence following one or more surgical attempts. There is no consensus of optimal pre-, peri-, and postoperative management such as timing, frequency, and duration of endocrine, radiologic, and ophthalmologic assessments as well as management of smaller tumor remnants or tumor recurrence. Conclusions In clinical practice, there is a great variation in the treatment and follow-up of patients with NFPAs. We have, based on available data, suggested an optimal management strategy for patients with NFPAs in relation to pituitary surgery. Prospective trials oriented at drawing up strategies for the management of NFPAs are needed.

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Copeptin and the syndrome of inappropriate antidiuresis (SIAD) after pituitary transsphenoidal surgery

Efthymiadis,

Pofi,

Rostom

et al. 2024

Endocrino Diabet & Metabol

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ObjectiveThis study evaluates the predictive value of copeptin for syndrome of inappropriate antidiuresis (SIAD) postpituitary transsphenoidal surgery (TSS).DesignData from 133 consecutive patients undergoing TSS (November 2017–October 2022) at Oxford University Hospitals NHS trust are presented in this retrospective study.MethodsLogistic regression (LR) and receiver operating characteristic (ROC) curves were performed to evaluate the diagnostic utility of copeptin. The Mann–Whitney U test was used to compare copeptin levels between the SIAD and no SIAD groups.ResultsFourteen patients (10.8%) developed SIAD. Copeptin was available in 121, 53 and 87 patients for Days 1, 241 and 8 post‐TSS, respectively. LR for Day 1 copeptin to predict SIAD gave an odds ratio (OR) of 1.0 (95%CI 42 0.84–1.20, p = .99), area under‐ROC curve (AUC) was 0.49; Day 2 copeptin OR was 0.65 (95%CI 0.39–1.19, 43 p = .77), AUC was 0.57 LR for Day 1 sodium to predict SIAD gave an odds ratio (OR) of 1.0 (95%CI 0.85–1.21, p = .99), AUC was 0.50.ConclusionsIn conclusion, our data provide no evidence for copeptin as a predictive marker for post‐TSS SIAD.

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A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery

Cited by 79 publications

References 36 publications

Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery

Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery

Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management

Copeptin and the syndrome of inappropriate antidiuresis (SIAD) after pituitary transsphenoidal surgery

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