Incidence, clinical manifestations, and course of water and electrolyte metabolism disturbances following transsphenoidal pituitary adenoma surgery: a prospective observational study

Abstract

Water and electrolyte disturbances occurred in the majority of patients undergoing transsphenoidal adenomectomy and were usually transient. Diabetes insipidus is more frequent than hyponatremia. Diabetes insipidus usually occurs during the 1st postoperative day and resolves in the majority of cases within 10 days. In few patients, DI may persist and require therapy with ADH analogs. Hyponatremia usually occurs at the end of the 1st postoperative week and resolves in most cases within 5 days. Very few patients will need treatment other than fluid-intake restriction to avoid serious complications. Thus, careful monitoring of the WEDs in patients undergoing transsphenoidal pituitary adenoma surgery is mandatory for the first 10 postoperative days.

Syndrome of alternating hypernatremia and hyponatremia after hypothalamic hamartoma surgery

“…3 Following surgery in the pituitary region, the sequential occurrence of CSW and SIADH has been previously demonstrated to occur in the same patient. 5,12,18 However, fluctuations in serum sodium levels resulting in sequential development of hypernatremia and hyponatremia have not been previously described following HH surgery; this entity is in line with other water electrolyte disturbances experienced after surgery in this region.…”

“…16 These authors suggested, as did others, that leakage of vasopressin from damaged hypothalamiconeurohypophysial tracts and the posterior pituitary causes an "isolated second phase" (hyponatremia). 5,16 In other studies, hyponatremia has been previously shown not to be associated with high levels of ADH but rather associated with elevated ANP, thought to have a role in CSW, after pituitary region surgery. 12,18 What likely happened in these 4 patients after resection of these very large tumors, most of which were removed aggressively, is a similar occurrence to the triphasic response.…”

“…A prior report regarding pituitary surgery found that combined DI and hyponatremia proceeded with hypernatremia on the 1st-3rd postoperative days followed by hyponatremia during postoperative Days 7.5-10. 5 Another study reviewed (in rats) the so-called triphasic response that occurs after pituitary stalk sectioning: DI, followed by hyponatreria, and DI again. 16 These authors suggested, as did others, that leakage of vasopressin from damaged hypothalamiconeurohypophysial tracts and the posterior pituitary causes an "isolated second phase" (hyponatremia).…”

“…11 Fluid restriction, however, as well as diuretic use in symptomatic patients, was suggested by 1 group as the sole treatment of hyponatremia occurring after pituitary surgery if the sodium level is less than 130 mEq/L (given that their group believed it to be a form of SIADH). 5 The same group suggested that hyponatremia is the more troublesome of the 2 extremes and could lead to significant morbidity and mortality if untreated but also warned that 1 patient developed acute renal failure during a period of fluid restriction during a hyponatremic state (sodium level of 127 mEq/L). 5 In addition to restricting fluid, we have used diuretics and saline replacement for treating hyponatremia.…”

Diabetes insipidus: the basic and clinical review

“…12,13 Surgery and tumors of supraoptic and paraventricular nuclear region can also be the cause of CDI. 14,15 CDI can also be due to the congenitally inherited mutations of prepro-vasopressin-neurophysin II gene involving the substitution of glycine for valine. 16 The other causes are autoimmunity, histocytosis, granulomatosis, sarcodosis and alcohol.…”