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Barber SM, Liebelt BD, Baskin DS. Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center. J Clin Med. 2014;3(4):1199-219doi: 10.3390/jcm3041199.
Barber, S. M., Liebelt, B. D., & Baskin, D. S. (2014). Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center. Journal of clinical medicine, 3(4), 1199-219. https://doi.org/10.3390/jcm3041199
Barber, Sean M, et al. "Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center." Journal of clinical medicine vol. 3,4 (2014): 1199-219. doi: https://doi.org/10.3390/jcm3041199
Barber SM, Liebelt BD, Baskin DS. Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center. J Clin Med. 2014 Oct 28;3(4):1199-219. doi: 10.3390/jcm3041199. PMID: 26237599; PMCID: PMC4470178.
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J Clin Med. 2014 Oct 28;3(4):1199-219. doi: 10.3390/jcm3041199.

Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center.

Journal of clinical medicine

Sean M Barber, Brandon D Liebelt, David S Baskin

Affiliations

  1. Department of Neurosurgery, Houston Methodist Neurological Institute and the Kenneth R, Peak Brain and Pituitary Tumor Treatment Center, 6560 Fannin St. Suite 944, Houston, TX 77030, USA.
  2. Department of Neurosurgery, Houston Methodist Neurological Institute and the Kenneth R, Peak Brain and Pituitary Tumor Treatment Center, 6560 Fannin St. Suite 944, Houston, TX 77030, USA. [email protected].

PMID: 26237599 PMCID: PMC4470178 DOI: 10.3390/jcm3041199

Abstract

Hyponatremia is often seen after transsphenoidal surgery and is a source of considerable economic burden and patient-related morbidity and mortality. We performed a retrospective review of 344 patients who underwent transsphenoidal surgery at our institution between 2006 and 2012. Postoperative hyponatremia was seen in 18.0% of patients at a mean of 3.9 days postoperatively. Hyponatremia was most commonly mild (51.6%) and clinically asymptomatic (93.8%). SIADH was the primary cause of hyponatremia in the majority of cases (n = 44, 71.0%), followed by cerebral salt wasting (n = 15, 24.2%) and desmopressin over-administration (n = 3, 4.8%). The incidence of postoperative hyponatremia was significantly higher in patients with cardiac, renal and/or thyroid disease (p = 0.0034, Objective Risk (OR) = 2.60) and in female patients (p = 0.011, OR = 2.18) or patients undergoing post-operative cerebrospinal fluid drainage (p = 0.0006). Treatment with hypertonic saline (OR = -2.4, p = 0.10) and sodium chloride tablets (OR = -1.57, p = 0.45) was associated with a non-significant trend toward faster resolution of hyponatremia. The use of fluid restriction and diuretics should be de-emphasized in the treatment of post-transsphenoidal hyponatremia, as they have not been shown to significantly alter the time-course to the restoration of sodium balance.

Keywords: SIADH; cerebral salt wasting; hyponatremia; pituitary adenoma; transsphenoidal

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