Abstract
PurposeHyponatraemia is a common complication following transsphenoidal surgery. However, there is sparse data on its optimal management and impact on clinical outcomes. The aim of this study was to evaluate the management and outcome of hyponatraemia following transsphenoidal surgery.MethodsA prospectively maintained database was searched over a 4-year period between January 2016 and December 2019, to identify all patients undergoing transsphenoidal surgery. A retrospective case-note review was performed to extract data on hyponatraemia management and outcome.ResultsHyponatraemia occurred in 162 patients (162/670; 24.2%) with a median age of 56 years. Female gender and younger age were associated with hyponatraemia, with mean nadir sodium being 128.6 mmol/L on postoperative day 7. Hyponatraemic patients had longer hospital stay than normonatraemic group with nadir sodium being inversely associated with length of stay (p < 0.001). In patients with serum sodium ≤ 132 mmol/L, syndrome of inappropriate antidiuretic hormone secretion (SIADH) was the commonest cause (80/111; 72%). Among 76 patients treated with fluid restriction as a monotherapy, 25 patients (25/76; 32.9%) did not achieve a rise in sodium after 3 days of treatment. Readmission with hyponatraemia occurred in 11 cases (11/162; 6.8%) at a median interval of 9 days after operation.ConclusionHyponatraemia is a relatively common occurrence following transsphenoidal surgery, is associated with longer hospital stay and risk of readmission and the effectiveness of fluid restriction is limited. These findings highlight the need for further studies to better identify and treat high-risk patients, including the use of arginine vasopressin receptor antagonists.
Highlights
Postoperative hyponatraemia, defined as serum sodium value less than 135 mmol/L within 30 days of surgery, is a frequent complication following transsphenoidal surgery for pituitary adenoma, with a reported incidence of 16–23%[1, 2, 19, 33, 36]
Mild hyponatraemia occurred in 90 patients (90/670; 13.4%), 38 patients had moderate hyponatraemia (38/670; 5.7%) and severe hyponatraemia was recorded in 34 patients (34/670; 5.1%)
We report the following principal findings: (1) the prevalence of post-operative hyponatraemia was 24.2%; (2) female gender and young age were associated with hyponatraemia; (3) tumour size, optic nerve compression, functional status of pituitary adenomas and surgical technique were not predictors for the development of postoperative hyponatraemia; (4) hyponatraemia was mainly due to SIADH, with day 4 being the median time of onset of hyponatraemia and nadir sodium being reported around seven days postoperatively; (5) fluid restriction was used as the treatment strategy in the majority of SIADH patients and was often ineffective in correcting hyponatraemia, leading to prolonged hospitalisation; 6) hyponatraemia was not associated with any long-term neurological sequalae or mortality
Summary
Postoperative hyponatraemia, defined as serum sodium value less than 135 mmol/L within 30 days of surgery, is a frequent complication following transsphenoidal surgery for pituitary adenoma, with a reported incidence of 16–23%[1, 2, 19, 33, 36]. Acta Neurochirurgica in SIADH, fluid and sodium replenishment are the treatment of choice in CSWS, whereas glucocorticoid and thyroxine replacement are required for adrenal and thyroid deficiency, respectively. Despite recent initiatives in the USA and the UK[4, 24], hyponatraemia remains the leading cause of unplanned hospital readmissions within 30 days of transsphenoidal surgery for pituitary tumours[3, 4, 6]. To this end, the aim of this study was to evaluate the management and outcome of hyponatraemia following transsphenoidal surgery
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