Impact of surgical factors on delayed hyponatremia in patients with nonfunctioning pituitary adenoma after endonasal endoscopic transsphenoidal procedure

Abstract

Purpose Delayed hyponatremia can occur after pituitary surgery, resulting in prolonged hospitalization. However, the influence of surgical factors after such a procedure has not been well established. The impact of surgery and related factors on delayed hyponatremia was investigated. Methods This was a retrospective analysis of 137 consecutive patients who underwent transsphenoidal surgery for a nonfunctioning pituitary adenoma between 2008 and 2019. Preoperative (demographics, comorbidities), intraoperative (resection extent, operation time, blood loss volume, cerebrospinal fluid leak, tumor consistency), and postoperative [hematoma, meningitis, diabetes insipidus (DI), hormonal assessment] data were collected, with statistical analysis of each factor performed. Results Among the 137 patients, delayed hyponatremia occurred in 31 (22.6%). Multivariate analysis revealed that those with hypertension had a significantly higher likelihood of avoiding delayed hyponatremia (p = 0.004). Although no correlations of direct surgical factors with delayed hyponatremia were found, multivariate analysis of indirect surgical factors showed that presence of a firm tumor, transient DI, and meningitis were significantly associated with delayed hyponatremia (p = 0.014, 0.001, and 0.047, respectively). There was also a significant association of severe hyponatremia with appearance of symptoms (p = 0.002). Conclusion There was a tendency for hypertension to be associated with delayed hyponatremia avoidance, with indirect surgical factors including tumor consistency, transient DI, and meningitis found to have an influence on delayed hyponatremia. It was concluded that attention should be given to non-hypertensive patients with a firm tumor, transient DI, or meningitis after pituitary surgery, as delayed hyponatremia may occur.

A simple scoring system for predicting the risk of delayed hyponatremia after endoscopic transsphenoidal surgery for pituitary adenomas.

“…Therefore, when patients develop Na (POD1 -POD2) ≥ 1 mEq/L, we can consider attempting prophylactic sodium supplementation through oral administration. Tanaka et al reported that postoperative transient diabetes insipidus (DI) may be a risk factor for delayed hyponatremia [22]. In our study, 3 cases of permanent DI were observed among the subjects, but they were not differentiated as transient or permanent DI in detail.…”

A Simple Scoring System for Predicting the Risk of Delayed Hyponatremia After Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

“…Therefore, when patients develop Na (POD1 -POD2) ≥1 mEq/L, we can consider attempting prophylactic sodium supplementation through oral administration. Tanaka et al reported that postoperative transient diabetes insipidus (DI) may be a risk factor for delayed hyponatremia [24]. Zada et al mentioned that patients who develop DI after surgery have a 48% increased risk of developing hyponatremia [12], which may be associated with injury to the pituitary stalk during the surgical procedure.…”

Gender potentially affects early postoperative hyponatremia in pituitary adenoma: XGBoost-based predictive modeling

“…These electrolyte imbalances can lead to adverse effects such as nausea, vomiting, altered mental status, and seizures, which can prolong hospitalization and increase the risk of readmission [ [4] , [5] , [6] , [7] ]. Mild electrolyte imbalances may present with non-specific symptoms, such as nausea and vomiting [ 8 ], and may go unnoticed. However, if left untreated, electrolyte imbalances can exacerbate and result in various neurological symptoms [ 9 ].…”