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

Abstract

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.

Predictors and dynamic online nomogram for postoperative delayed hyponatremia after endoscopic transsphenoidal surgery for pituitary adenomas: a single-center, retrospective, observational cohort study with external validation

“…The incidence rate of PDH varies widely among publications, ranging from 2 to 35% [ 1 , 6 ]. One possible explanation for the wide range of incidence rates among different publications is the inconsistence in the diagnostic criteria used for PDH.…”

“…Previous research has reported various predictors for PDH, including old age, serum sodium concentrations on postoperative days (POD) 1 and 2 [ 2 – 5 ], postoperative diabetes insipidus, diaphragma sellae sinking depth, and postoperative length of the “measurable pituitary stalk” [ 6 ]. However, the relation between tumor type, tumor size, and PDH has not reached a consistent conclusion [ 1 ].…”

“…Nomogram is a user-friendly integrated predictive tool, providing visualization of complex predictive models by incorporating multiple predictors [ 7 ]. Lin et al developed a nomogram to predict PDH [ 6 ]. However, the potential predictors included in their study were not thoroughly explored, and the nomogram they constructed was not developed as an online tool, which restricted its practical application.…”

Predictive Model of Delayed Hyponatremia after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenoma

“…Upon admission, all patients undergo radiological examination to observe tumor location and its relationship with surrounding tissues, classi ed into Knosp grades 0-4 [9] . The angle of deviation of the pituitary stalk is recorded on T1 + C scans, de ned as the angle at which the pituitary stalk deviates from the midline at its point of origin [10] (Fig. 1).…”

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

“…Pituitary adenomas constitute 10–15% of intracranial tumors and are the most prevalent sellar lesion [ 1 ]. The primary treatment for pituitary adenomas is transnasal sphenoid surgery, which has a low incidence of complications [ 2 ].…”