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Diabetes insipidus and syndrome of inappropriate antidiuresis (SIADH) after pituitary surgery: incidence and risk factors.
Neurosurgical Review ( IF 2.8 ) Pub Date : 2020-06-24 , DOI: 10.1007/s10143-020-01340-0
Elena L Sorba 1 , Victor E Staartjes 1 , Stefanos Voglis 1 , Lazar Tosic 1 , Giovanna Brandi 2 , Oliver Tschopp 3 , Carlo Serra 1 , Luca Regli 1
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Electrolyte disorders are relatively frequent and potentially serious complications after pituitary surgery. Both DI (diabetes insipidus) and SIADH (syndrome of inappropriate antidiuresis) can complicate and prolong hospital and intensive care unit stay, and the latter may even be preventable. We aim to assess the incidence of both electrolyte disorders and their risk factors. From a prospective registry of patients who underwent endoscopic transnasal transsphenoidal surgery (TSS) for pituitary adenoma, patients with postoperative DI and SIADH were identified. Univariable and multivariable statistics were carried out to identify factors independently associated with the occurrence of either DI or SIADH. A total of 174 patients were included, of which 73 (42%) were female. Mean age was 54 years (range 20–88). During postoperative hospital stay, 13 (7.5%) patients presenting with DI and 11 (6.3%) with SIADH were identified. Patients who developed DI after surgery had significantly longer hospital stays (p = 0.022), as did those who developed SIADH (p = 0.002). Four (2.3%) patients were discharged with a diagnosis of persistent DI, and 2 (1.1%) with the diagnosis of SIADH. At the last follow-up, 5 (2.9%) patients presented with persistent DI, while none of the patients suffered from SIADH. Younger age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.01, p = 0.166) and pituitary apoplexy (OR 2.69, 95% CI 0.53–10.65, p = 0.184) were weakly associated with the occurrence of DI. We identified younger age (OR 0.96, 95% CI 0.92–0.99, p = 0.045) and lower preoperative serum sodium (OR 0.83, 95% CI 0.71–0.95, p = 0.008) as independent risk factors for SIADH. Although we found a weak association among age, pituitary apoplexy, and the occurrence of DI, no independent predictor was identified for DI. For postoperative SIADH however, lower age and preoperative serum sodium were identified as significant predictors. None of these findings were sufficiently supported by preexisting literature. Both electrolyte disorders are exquisitely hard to predict preoperatively, and further research into their early detection and prevention is warranted.



中文翻译:

垂体手术后尿崩症和抗利尿不当综合征(SIADH):发病率和危险因素。

垂体手术后电解质紊乱相对频繁,潜在的严重并发症。DI(尿崩症)和SIADH(抗利尿不当综合症)都可能使医院和重症监护病房住院时间延长,并使病情复杂化,甚至可以预防。我们旨在评估电解质紊乱的发生率及其危险因素。从前瞻性登记的垂体腺瘤接受内镜经鼻经鼻蝶窦手术(TSS)的患者中,鉴定出术后DI和SIADH患者。进行了单变量和多变量统计,以识别与DI或SIADH的发生独立相关的因素。包括174位患者,其中73位(42%)为女性。平均年龄为54岁(范围20-88)。术后住院期间,确定了13位(7.5%)的DI患者和11位(6.3%)的SIADH患者。手术后发生DI的患者住院时间明显延长(p  = 0.022),以及那些发展了SIADH的人(p  = 0.002)。4例(2.3%)患者出院,诊断为持续性DI,2例(1.1%)诊断为SIADH。在最后一次随访中,有5名(2.9%)患者表现出持续性DI,而没有患者遭受SIADH。年龄较小(比值(OR)0.97,95%置信区间(CI)0.94–1.01,p  = 0.166)和垂体中风(OR 2.69,95%CI 0.53–10.65,p  = 0.184)与以下疾病的发生相关DI 我们确定年龄较小(OR 0.96,95%CI 0.92–0.99,p  = 0.045)和较低的术前血清钠(OR 0.83,95%CI 0.71–0.95,p = 0.008)作为SIADH的独立危险因素。尽管我们发现年龄,垂体中风和DI的发生之间存在弱关联,但并未确定DI的独立预测因子。然而,对于术后SIADH,较低的年龄和术前血清钠被确定为重要的预测指标。这些发现没有一个得到现有文献的充分支持。两种电解质紊乱都很难在术前预测,因此有必要对其早期发现和预防进行进一步研究。

更新日期:2020-06-24
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