Kunzhe Lin1, Jun Li2, Lingling Lu1, Shangming Zhang2, Shuwen Mu1, Zhijie Pei1, Cheng Wang1, Jingying Lin3, Liang Xue2, Liangfeng Wei2, Lin Zhao2, Shousen Wang4,5. 1. Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China. 2. Department of Neurosurgery, 900th Hospital, Fuzhou, 350025, China. 3. Fuzong Clinical Medical College, Fujian University Traditional Chinese Medicine, Fuzhou, 350122, China. 4. Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, China. wshsen1965@126.com. 5. Department of Neurosurgery, 900th Hospital, Fuzhou, 350025, China. wshsen1965@126.com.
Abstract
PURPOSE: Sinking of the diaphragma sellae (DS) may stretch the pituitary stalk, which in turn impairs neurohypophyseal function; thus, it may play a role in the development of postoperative hyponatremia. We aimed to assess the factors influencing the development of hyponatremia after transsphenoidal surgery (TSS) for pituitary adenomas and analyze the effect of DS sinking on hyponatremia. METHODS: After applying the inclusion and exclusion criteria, we retrospectively analyzed the clinical data of patients with pituitary adenoma who underwent TSS. The pituitary gland was scanned using a 3.0-T magnetic resonance imaging, and sagittal and coronal images were acquired. We evaluated the following: preoperative and postoperative hypothalamus‒pituitary‒thyroid axis function, hypothalamus‒pituitary‒adrenal axis function, intra-operative cerebrospinal fluid leaks, diabetes insipidus, hyponatremia, time from the day of surgery to the day of discharge, and time of hyponatremia onset. RESULTS: Of the 460 patients who had microscopic TSS for pituitary adenoma, 83 experienced postoperative hyponatremia. Hyponatremia occurred approximately 5.25 days postoperatively and persisted for 5.54 days. The lowest average blood sodium level was 123.9 mEq/L, which occurred at 7.49 days after surgery. Logistic regression analysis showed that the risk of hyponatremia was greater for patients with a significant DS sinking depth, a large pituitary stalk deviation angle difference, and a longer postoperative "measurable pituitary stalk". The difference in blood sodium levels between pre-TSS and 2 days post-TSS was also an independent predictor of postoperative hyponatremia onset. CONCLUSION: DS sinking plays an important role in predicting hyponatremia onset after TSS for pituitary adenomas.
PURPOSE: Sinking of the diaphragma sellae (DS) may stretch the pituitary stalk, which in turn impairs neurohypophyseal function; thus, it may play a role in the development of postoperative hyponatremia. We aimed to assess the factors influencing the development of hyponatremia after transsphenoidal surgery (TSS) for pituitary adenomas and analyze the effect of DS sinking on hyponatremia. METHODS: After applying the inclusion and exclusion criteria, we retrospectively analyzed the clinical data of patients with pituitary adenoma who underwent TSS. The pituitary gland was scanned using a 3.0-T magnetic resonance imaging, and sagittal and coronal images were acquired. We evaluated the following: preoperative and postoperative hypothalamus‒pituitary‒thyroid axis function, hypothalamus‒pituitary‒adrenal axis function, intra-operative cerebrospinal fluid leaks, diabetes insipidus, hyponatremia, time from the day of surgery to the day of discharge, and time of hyponatremia onset. RESULTS: Of the 460 patients who had microscopic TSS for pituitary adenoma, 83 experienced postoperative hyponatremia. Hyponatremia occurred approximately 5.25 days postoperatively and persisted for 5.54 days. The lowest average blood sodium level was 123.9 mEq/L, which occurred at 7.49 days after surgery. Logistic regression analysis showed that the risk of hyponatremia was greater for patients with a significant DS sinking depth, a large pituitary stalk deviation angle difference, and a longer postoperative "measurable pituitary stalk". The difference in blood sodium levels between pre-TSS and 2 days post-TSS was also an independent predictor of postoperative hyponatremia onset. CONCLUSION: DS sinking plays an important role in predicting hyponatremia onset after TSS for pituitary adenomas.
Authors: Dina Winograd; Kristen A Staggers; Sherly Sebastian; Masayoshi Takashima; Daniel Yoshor; Susan L Samson Journal: Neurosurgery Date: 2020-09-15 Impact factor: 4.654
Authors: Elena L Sorba; Victor E Staartjes; Stefanos Voglis; Lazar Tosic; Giovanna Brandi; Oliver Tschopp; Carlo Serra; Luca Regli Journal: Neurosurg Rev Date: 2020-06-24 Impact factor: 3.042
Authors: Michael A Bohl; Shah Ahmad; Heidi Jahnke; Deborah Shepherd; Laura Knecht; William L White; Andrew S Little Journal: Neurosurgery Date: 2016-01 Impact factor: 4.654
Authors: M Araujo-Castro; F Mariño-Sánchez; A Acitores Cancela; A García Fernández; S García Duque; V Rodríguez Berrocal Journal: J Endocrinol Invest Date: 2020-10-11 Impact factor: 4.256