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

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
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J. Clin. Med. 2014, 3(4), 1199-1219; https://doi.org/10.3390/jcm3041199
Received: 30 July 2014 / Revised: 23 September 2014 / Accepted: 27 September 2014 / Published: 28 October 2014
(This article belongs to the Special Issue Hyponatremia: Advances in Diagnosis and Management)
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. View Full-Text
Keywords: hyponatremia; SIADH; pituitary adenoma; transsphenoidal; cerebral salt wasting hyponatremia; SIADH; pituitary adenoma; transsphenoidal; cerebral salt wasting
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Barber, S.M.; Liebelt, B.D.; Baskin, D.S. Incidence, Etiology and Outcomes of Hyponatremia after Transsphenoidal Surgery: Experience with 344 Consecutive Patients at a Single Tertiary Center. J. Clin. Med. 2014, 3, 1199-1219.

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