Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan.
Pituitary. 2023 Feb;26(1):42-50. doi: 10.1007/s11102-022-01288-y. Epub 2022 Nov 2.
Delayed postoperative hyponatremia (DPH) is a unique complication of transsphenoidal surgery (TSS) in pituitary tumors. Growth hormone (GH) enhances renal sodium reabsorption; however, the association between postoperative GH reduction and DPH in acromegaly is unclear. This study was performed to clarify the incidence of and the predictive factors for DPH in patients with acromegaly who underwent TSS.
Ninety-four patients with active acromegaly were examined retrospectively. During the postoperative course, patients with serum sodium levels ≤ 134 mEq/L were classified into the DPH group. We compared basic clinical characteristics, tumor characteristics, and preoperative and postoperative examination findings between the DPH and non-DPH groups.
DPH occurred in 39 patients (41.5%), and the lowest serum sodium levels were generally observed during postoperative days (PODs) 7-9. They needed a 3-day longer hospital stay than those without DPH. The DPH group had lower preoperative body weight and body mass index. In addition, a transient increase in body weight during PODs 5-7 occurred with a transient decrease in urinary volume in the DPH group. Preoperative and postoperative GH and insulin-like growth factor-1 levels did not differ between the two groups.
The findings suggested that lower preoperative weight and a postoperative transient gain in body weight are associated with an increased risk of DPH in acromegaly patients undergoing transsphenoidal surgery.
迟发性术后低钠血症（DPH）是垂体瘤经蝶窦手术（TSS）的一种独特并发症。生长激素（GH）增强肾脏钠重吸收；然而，术后 GH 减少与肢端肥大症 DPH 之间的关联尚不清楚。本研究旨在阐明 TSS 治疗后肢端肥大症患者 DPH 的发生率和预测因素。
回顾性检查了 94 例活动性肢端肥大症患者。在术后过程中，血清钠水平≤134mEq/L 的患者被分为 DPH 组。我们比较了 DPH 组和非 DPH 组之间的基本临床特征、肿瘤特征以及术前和术后检查结果。
39 例（41.5%）发生 DPH，最低血清钠水平通常在术后第 7-9 天观察到。他们的住院时间比没有 DPH 的患者长 3 天。DPH 组术前体重和体重指数较低。此外，DPH 组在术后第 5-7 天出现体重短暂增加，同时尿排量短暂减少。两组患者术前和术后 GH 和胰岛素样生长因子-1 水平无差异。
这些发现表明，术前较低的体重和术后体重的短暂增加与接受经蝶窦手术的肢端肥大症患者 DPH 的风险增加有关。
