Postoperative Diabetes Insipidus and Hyponatremia in Children after Transsphenoidal Surgery for Adrenocorticotropin Hormone and Growth Hormone Secreting Adenomas
| Autor: | Maya Lodish, Ninet Sinaii, C. Lyssikatos, Margaret F. Keil, Carolina Saldarriaga, Constantine A. Stratakis, Prashant Chittiboina, Elena Belyavskaya |
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| Rok vydání: | 2018 |
| Předmět: |
Transsphenoidal surgery
medicine.medical_specialty business.industry Urine specific gravity medicine.medical_treatment 030209 endocrinology & metabolism Adrenocorticotropic hormone medicine.disease Gastroenterology 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Posterior pituitary Internal medicine Pediatrics Perinatology and Child Health Diabetes insipidus Syndrome of inappropriate antidiuretic hormone secretion medicine business Hyponatremia Desmopressin 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | The Journal of Pediatrics. 195:169-174.e1 |
| ISSN: | 0022-3476 |
| DOI: | 10.1016/j.jpeds.2017.11.042 |
| Popis: | Objectives To define the incidence and risk factors of postoperative sodium alterations in pediatric patients undergoing transsphenoidal surgery (TSS) for adrenocorticotropic hormone and growth hormone secreting pituitary adenomas. Study design We retrospectively reviewed 160 patients ≤18 years of age who had TSS for pituitary adenomas at our institution from 1999 to 2017. Variables included daily serum sodium through postoperative day 10, urine specific gravity, and medications administered. We examined associations between sex, repeat surgery, manipulation of the posterior pituitary (PP), tumor invasion into the PP, tumor type and size, cerebrospinal fluid (CSF) leak, lumbar drain insertion, body mass index, puberty, and development of diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH). Results Mean age was 12.9 ± 3.4 years (female = 81). Patients had adrenocorticotropic hormone (150/160) and growth hormone (10/160) producing adenomas. Forty-two (26%) patients developed DI. Among the 37 of 160 who required desmopressin acutely, 13 of 37 required it long term. Risk of long-term need for desmopressin was significantly higher in patients who had CSF leak 9 of 48 (P = .003), lumbar drain 6 of 30 (P = .019), manipulation 11 of 50 (P Conclusions Among 160 children who underwent TSS for pituitary adenomas, the incidence of DI and SIADH after TSS was 26% and 14%, respectively. Combined risk factors for DI and/or SIADH include female sex, manipulation of and/or tumor invasion into the PP, and CSF leak or lumbar drain. Trial registration ClinicalTrials.gov : NCT00001595 and NCT00060541 . |
| Databáze: | OpenAIRE |
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