Breshears Jonathan D, Jiang Bowen, Rowland Nathan C, Kunwar Sandeep, Blevins Lewis S
California Center for Pituitary Disorders, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Clin Neurol Neurosurg. 2013 Nov;115(11):2358-61. doi: 10.1016/j.clineuro.2013.08.019. Epub 2013 Aug 27.
Hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common osmoregulatory complication following surgery for Cushing's disease. Conventional management includes water restriction and sodium repletion, however this regimen does not address the underlying pathophysiology of excessive vasopressin production. Vaptans are arginine vasopressin receptor antagonists shown to be effective in correcting water excess in other disease states of euvolemic and hypervolemic hyponatremia. The use of these agents has not been reported in Cushing's patients.
We retrospectively studied Cushing's patients at our institution with post-surgical hyponatremia (Na<130mEq/L) treated with and without conivaptan between 2005 and 2011. We report rates of serum sodium normalization and compare length-of-stay (LOS) between the groups.
Hyponatremia developed in six of 98 patients (6.1%) undergoing resection of ACTH-positive pituitary adenomas. Three patients received conivaptan and fluid restriction±sodium supplementation, and three received conventional therapy alone. The rate of serum sodium normalization with conivaptan was 5.8±2.3mEq/L/20mg IV bolus given every 24h. All patients receiving conivaptan were discharged with normal serum sodium values and no instances of rapid overcorrection occurred. A trend toward longer LOS occurred in patients treated with conivaptan (4.6±0.3 days, mean±SE) versus conventional therapy alone (1.6±0.3 days).
Conivaptan is a potentially useful treatment option for hyponatremia in the setting of Cushing's disease patients after pituitary surgery.
抗利尿激素分泌不当综合征（SIADH）所致低钠血症是库欣病手术后常见的渗透调节并发症。传统治疗方法包括限水和补充钠，但该方案未解决血管加压素分泌过多的潜在病理生理学问题。血管加压素受体拮抗剂在纠正等容性和高容性低钠血症的其他疾病状态下的水过多方面已显示有效。这些药物在库欣病患者中的应用尚未见报道。
我们回顾性研究了2005年至2011年间在本机构接受垂体手术后发生低钠血症（血钠<130mEq/L）且接受或未接受考尼伐坦治疗的库欣病患者。我们报告血钠正常化率，并比较两组之间的住院时间（LOS）。
98例接受促肾上腺皮质激素（ACTH）阳性垂体腺瘤切除术的患者中有6例（6.1%）发生低钠血症。3例患者接受考尼伐坦及限液±补钠治疗，3例仅接受传统治疗。考尼伐坦使血钠正常化的速率为每24小时静脉推注20mg时5.8±2.3mEq/L。所有接受考尼伐坦治疗的患者出院时血钠值均正常，且未发生快速纠正过度的情况。与仅接受传统治疗的患者（1.6±0.3天）相比，接受考尼伐坦治疗的患者住院时间有延长趋势（4.6±0.3天，均值±标准误）。
考尼伐坦对于垂体手术后库欣病患者的低钠血症可能是一种有用的治疗选择。
