A high incidence of sodium alterations occurs in children following transsphenoidal surgery (TSS) for pituitary adenomas and, along with female gender, manipulation of and/or tumor invasion into the posterior pituitary (PP), and cerebrospinal fluid (CSF) leak or lumbar drain, may contribute to the development of diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH), according to a retrospective study in The Journal of Pediatrics.
Limited data exist on the predictors and incidence of sodium alterations following TSS in children; therefore researchers reviewed 160 patients age ≤18 who had TSS for pituitary adenomas from 1999 to 2017.
Of the 160 patients, 42 (26%) developed DI. Of these patients, 37required short-term treatment with desmopressin, while 13 required long-term treatment. The need for long-term treatment with desmopressin was significantly higher in patients who had a cerebrospinal fluid (CSF) leak (n=9/48, P =.003), lumbar drain (n=6/30, P =.019), and manipulation (n=11/50, P <.001) or invasion of the PP (n=4/15, P =.022).
Hyponatremia only (without DI) occurred in 60 patients; 19 instances were due to SIADH, 39 to hypotonic fluids, and 2 to cerebral salt wasting syndrome. Female patients were more likely to develop SIADH compared with male patients (20% vs 8%, respectively, P =.026).
The investigators concluded, “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.” These data can be applied clinically to help identify patients at high-risk who need more aggressive follow-up postoperatively.
Saldarriaga C, Lyssikatos C, Belyavskaya E, et al. Postoperative diabetes insipidus and hyponatremia in children after transsphenoidal surgery for adrenocorticotropin hormone and growth hormone secreting adenomas [published online January 30, 2018]. J Pediatr. doi:10.1016/j.jpeds.2017.11.042