Sorba Elena L, Staartjes Victor E, Voglis Stefanos, Tosic Lazar, Brandi Giovanna, Tschopp Oliver, Serra Carlo, Regli Luca
Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Neurosurgical Intensive Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Neurosurg Rev. 2021 Jun;44(3):1503-1511. doi: 10.1007/s10143-020-01340-0. Epub 2020 Jun 24.
Electrolyte disorders are relatively frequent and potentially serious complications after pituitary surgery. Both DI (diabetes insipidus) and SIADH (syndrome of inappropriate antidiuresis) can complicate and prolong hospital and intensive care unit stay, and the latter may even be preventable. We aim to assess the incidence of both electrolyte disorders and their risk factors. From a prospective registry of patients who underwent endoscopic transnasal transsphenoidal surgery (TSS) for pituitary adenoma, patients with postoperative DI and SIADH were identified. Univariable and multivariable statistics were carried out to identify factors independently associated with the occurrence of either DI or SIADH. A total of 174 patients were included, of which 73 (42%) were female. Mean age was 54 years (range 20-88). During postoperative hospital stay, 13 (7.5%) patients presenting with DI and 11 (6.3%) with SIADH were identified. Patients who developed DI after surgery had significantly longer hospital stays (p = 0.022), as did those who developed SIADH (p = 0.002). Four (2.3%) patients were discharged with a diagnosis of persistent DI, and 2 (1.1%) with the diagnosis of SIADH. At the last follow-up, 5 (2.9%) patients presented with persistent DI, while none of the patients suffered from SIADH. Younger age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-1.01, p = 0.166) and pituitary apoplexy (OR 2.69, 95% CI 0.53-10.65, p = 0.184) were weakly associated with the occurrence of DI. We identified younger age (OR 0.96, 95% CI 0.92-0.99, p = 0.045) and lower preoperative serum sodium (OR 0.83, 95% CI 0.71-0.95, p = 0.008) as independent risk factors for SIADH. Although we found a weak association among age, pituitary apoplexy, and the occurrence of DI, no independent predictor was identified for DI. For postoperative SIADH however, lower age and preoperative serum sodium were identified as significant predictors. None of these findings were sufficiently supported by preexisting literature. Both electrolyte disorders are exquisitely hard to predict preoperatively, and further research into their early detection and prevention is warranted.
垂体手术后电解质紊乱是较为常见且可能严重的并发症。尿崩症（DI）和抗利尿激素分泌失调综合征（SIADH）都会使住院时间和重症监护病房停留时间延长并使病情复杂化，而后者甚至可能是可预防的。我们旨在评估这两种电解质紊乱的发生率及其风险因素。从一个针对因垂体腺瘤接受鼻内镜经蝶窦手术（TSS）患者的前瞻性登记系统中，识别出术后发生DI和SIADH的患者。进行单变量和多变量统计以确定与DI或SIADH发生独立相关的因素。共纳入174例患者，其中73例（42%）为女性。平均年龄为54岁（范围20 - 88岁）。在术后住院期间，识别出13例（7.5%）发生DI的患者和11例（6.3%）发生SIADH的患者。术后发生DI的患者住院时间显著更长（p = 0.022），发生SIADH的患者也是如此（p = 0.002）。4例（2.3%）患者出院时诊断为持续性DI，2例（1.1%）诊断为SIADH。在最后一次随访时，5例（2.9%）患者存在持续性DI，而无患者患有SIADH。年龄较小（比值比（OR）0.97，95%置信区间（CI）0.94 - 1.01，p = 0.166）和垂体卒中（OR 2.69，95% CI 0.53 - 10.65，p = 0.184）与DI的发生弱相关。我们确定年龄较小（OR 0.96，95% CI 0.92 - 0.99，p = 0.045）和术前血清钠水平较低（OR 0.83，95% CI 0.71 - 0.95，p = 0.008）是SIADH的独立危险因素。尽管我们发现年龄、垂体卒中与DI的发生之间存在弱关联，但未识别出DI的独立预测因素。然而，对于术后SIADH，年龄较小和术前血清钠被确定为显著预测因素。现有文献均未充分支持这些发现。这两种电解质紊乱在术前都极难预测，有必要对其早期检测和预防进行进一步研究。
