Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery

Abstract Objective. Surgical manipulation of the pituitary stalk, neurohypophysis or the hypothalamus may disturb control of the plasma sodium level. The factors that might predict the risk of postoperative sodium imbalance are not clear, and were investigated in this study. Methods. A retrospective...

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Bibliographic Details
Published in:British journal of neurosurgery 2013-02, Vol.27 (1), p.63-68
Main Authors: Staiger, Roxane D., Sarnthein, Johannes, Wiesli, Peter, Schmid, Christoph, Bernays, René L.
Format: Article
Language:English
Subjects:
Adenoma - blood
Adenoma - pathology
Adenoma - surgery
Adult
Aged
Analysis of Variance
antidiuretic hormone ADH
diabetes
Diabetes Insipidus, Neurogenic - etiology
Female
Health risk assessment
Homeostasis
Homeostasis - physiology
Humans
hypernatraemia
Hypernatremia - blood
Hypernatremia - etiology
Hypernatremia - pathology
hyponatraemia
Hyponatremia - blood
Hyponatremia - etiology
Hyponatremia - pathology
Male
Middle Aged
Neurology
Neurosurgery
pituitary
Pituitary Neoplasms - blood
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Postoperative Complications - blood
Postoperative Complications - etiology
Postoperative Complications - pathology
Retrospective Studies
sella turcica
Sella Turcica - surgery
Sodium
Sodium - blood
Surgical outcomes
Tumor Burden
Tumors
Vasopressins - metabolism
Young Adult
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Summary:Abstract Objective. Surgical manipulation of the pituitary stalk, neurohypophysis or the hypothalamus may disturb control of the plasma sodium level. The factors that might predict the risk of postoperative sodium imbalance are not clear, and were investigated in this study. Methods. A retrospective survey of 129 surgical records for the occurrence of plasma sodium levels outside the normal range, following transsphenoidal procedures. Median patient age was 49 (range 20-78) years, 65 female. 73 of the operated lesions were non-functioning pituitary adenomas. Patients were considered to have impaired plasma sodium balance if the range of 135-145 mmol/L was not maintained. Results. Of all 129 surgical cases, 68 (53%) experienced an imbalance in sodium levels. Severe sodium imbalance (≥ 149 or ≤ 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6). Tumour size was associated with an increased incidence of sodium imbalance, particularly in patients younger than 49 years; surgery resulted in sodium imbalance in 38% of young patients operated on for tumours
ISSN:0268-8697
1360-046X
DOI:10.3109/02688697.2012.714013