Diaphragma sellae sinking can predict the onset of hyponatremia after transsphenoidal surgery for pituitary adenomas

Lin, Kunzhe; Li, Jun; Lu, Lingling; Zhang, Shangming; Mu, Shuwen; Pei, Zhijie; Wang, Cheng; Lin, Jing‐Ying; Xue, Liang; Wei, Liangfeng; Zhang, Lin

doi:10.1007/s40618-021-01611-7

Cited by 14 publications

(12 citation statements)

References 33 publications

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“…Previously, we proposed that descent of the diaphragma sellae could be a possible cause of hypothalamus-neurohypophysis tract injury ( 22 ). After tumor removal, the subsidence of the diaphragma sellae usually pulls the pituitary stalk, which can lead to abnormal secretion of ADH and cause delayed hyponatremia ( 16 ). Previous studies used statistical methods, such as univariate and multivariate analysis to determine the predictors.…”

Section: Discussionmentioning

confidence: 99%

“…The difference between the deviation angle of the pituitary stalk preoperatively and postoperatively was calculated (i.e., pituitary stalk deviation angle difference). The length of the “measurable pituitary stalk” and the sinking depth of the diaphragma sellae were measured and calculated according to Lin’s method ( Figures 2 , 3 ) ( 16 ). Tumor volume was calculated using the platform-like volume calculation formula ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

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Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Lin

Zeng²,

et al. 2022

Front. Endocrinol.

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ObjectiveThis study aimed to develop a nomogram of clinical variables and magnetic resonance imaging scans to predict delayed hyponatremia after transsphenoidal surgery for pituitary adenoma.MethodsPatients who underwent transsphenoidal surgery for pituitary adenoma in Fuzong Clinical Medical College of Fujian Medical University between January 2012 and December 2020 were retrospectively investigated. Medical records, MRI findings, and laboratory examination results were recorded as candidate variable predictors of delayed hyponatremia. A nomogram to predict delayed hyponatremia was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of the nomogram were assessed using the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analyses. The model underwent prospective validation in three medical centers with patients who underwent transsphenoidal surgery for pituitary adenoma between January 2021 and February 2022.ResultsThe model that incorporated the postoperative length of “measurable pituitary stalk,” pituitary stalk deviation angle difference, postoperative diabetes insipidus, sinking depth of diaphragma sellae, and blood sodium level on the second postoperative day was developed and presented as the nomogram of the training cohort. The nomogram achieved area under the ROC curve (AUCs) of 0.806 and 0.849 for the training cohort and the testing cohort, respectively, and displayed good calibration. Decision curve analysis showed that the nomogram was clinically useful when the threshold probability was 13–96%.ConclusionsWe developed a nomogram to evaluate the individualized prediction of delayed hyponatremia after transsphenoidal surgery for pituitary adenomas.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Lin

Zeng²,

et al. 2022

Front. Endocrinol.

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“…Most pituitary adenomas grow by pushing the sellar diaphragm, which sinks with surgical resection of the tumor ( 21 ). Recent reports suggest that the subsidence of the sellar diaphragm leads to pituitary stalk injury, which in turn leads to hyponatremia after TSS for pituitary adenoma ( 22 ). We believe that the larger the craniocaudal diameter, the more obvious the subsidence of the sellar diaphragm after tumor resection, and the greater the probability of delayed postoperative hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed postoperative hyponatremia in patients with non-functioning pituitary adenomas undergoing transsphenoidal surgery: A single-institution study

Huang

Wang²,

Wu³

et al. 2022

Front. Neurol.

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PurposeWe aimed to assess factors influencing the occurrence of delayed hyponatremia after transsphenoidal surgery (TSS) in patients with a non-functional pituitary adenoma (NFPA).MethodsWe retrospectively collected the clinical data of patients who underwent TSS for NFPA between January 2016 and January 2021. The pituitary region was preoperatively scanned with 3.0 T magnetic resonance imaging. The risk factors for delayed postoperative hyponatremia for NFPA were identified by univariate and multivariable logistic regression analysis.ResultsWe selected 166 patients with NFPA who fulfilled the inclusion criteria. Delayed postoperative hyponatremia occurred in 28 patients and did not in 138. Multivariable logistic regression analyses demonstrated that higher odds of developing delayed postoperative hyponatremia were independently associated with larger craniocaudal dimension (OR = 1.128, P = 0.034), as well as preoperative hyperprolactinemia (OR = 2.618, P = 0.045) and larger preoperative pituitary stalk deviation angle (OR = 3.033, P = 0.022).ConclusionWe identified the independent risk factors for delayed hyponatremia after TSS for NFPA; these included preoperative hyperprolactinemia, craniocaudal diameter, and preoperative pituitary stalk deviation angle.

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“…The pituitary region was scanned using 3.0 T MRI. Diaphragma sellae height was measured on T2-weighted images from the plane where the diaphragma sellae begins its elevation to the plane at which the highest point of the diaphragma sellae is located ( Figure 1 ) ( 10 ). The appearance and location of posterior pituitary bright spots were observed on T1-weighted images ( Figure 2 ) ( 11 ).…”

Section: Methodsmentioning

confidence: 99%

Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts

et al. 2022

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PurposeWe aimed to assess factors influencing the occurrence of delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts (RCCs).MethodsWe retrospectively collected the clinical data of patients who underwent transsphenoidal surgery for RCCs from January 2014 to January 2022. Univariate and multivariate analyses were used to determine the factors influencing the occurrence of postoperative delayed hyponatremia.ResultsOf the 78 microscopic transsphenoidal surgery recipients with RCCs, 15 experienced postoperative delayed hyponatremia. There were 35 men and 43 women, and mean age was 43.75 ± 14.95 years. The clinical manifestations of RCCs were headache (62 cases, 79.5%), visual dysfunction (35 cases, 44.9%), endocrine dysfunction symptoms (12 cases, 15.4%). After transsphenoidal surgery, 93.5% (58/62) had improvements in headache, and 97.1% (34/35) had improved or resolved compressive visual symptoms. Delayed hyponatremia occurred on average on day 6.46 and lasted on average for 4.40 days. Logistic regression analysis showed that the independent influencing factor of delayed hyponatremia after transsphenoidal surgery in patients with RCCs was postoperative diaphragma sellae height.ConclusionPostoperative diaphragma sellae height was identified as an independent influencing factor for delayed hyponatremia after transsphenoidal surgery in patients with RCCs.

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Diaphragma sellae sinking can predict the onset of hyponatremia after transsphenoidal surgery for pituitary adenomas

Cited by 14 publications

References 33 publications

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Novel Nomograms to Predict Delayed Hyponatremia After Transsphenoidal Surgery for Pituitary Adenoma

Risk factors for delayed postoperative hyponatremia in patients with non-functioning pituitary adenomas undergoing transsphenoidal surgery: A single-institution study

Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with Rathke’s cleft cysts

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