Constanthin Paul E, Isidor Nathalie, De Seigneux Sophie, Momjian Shahan
Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland.
Faculty of Medicine, Université de Genève (UNIGE), Geneva, Switzerland.
Endocrine. 2025 Apr;88(1):262-272. doi: 10.1007/s12020-024-04131-5. Epub 2024 Dec 17.
Transient arginine vasopressin deficiency (AVP-D), previously called diabetes insipidus, is a well-known complication of transsphenoidal pituitary surgery (TPS) with no definite predictive biomarker to date making it difficult to anticipate. While oxytocin (OXT) was previously suggested as a possible biomarker to predict syndrome of inappropriate diuresis (SIAD)-related hyponatraemia after TPS, its secretion in patients presenting with AVP-D remains poorly understood. We therefore hypothesized that OXT might present a different secretion in the case of AVP-D which would support its potential as an early biomarker of AVP-D. Moreover, we hypothesized that abnormal secretion of OXT might occur later on, notably with SIAD.
We measured the urinary output of OXT in 67 consecutive patients subjected to TPS and compared the values of oxytocin between time-points and OXT ratio between groups. The primary endpoint of our study was to identify a difference in urinary OXT excretion in patients suffering from AVP-D compared to patients remaining normonatraemic. As a secondary endpoint, we compared the evolution of OXT secretion after the diagnosis of AVP-D in both groups, comparing the patients that later developed SIAD with the ones that did not.
Patients developing AVP-D showed a delay in the increase of OXT secretion after TPS as shown by a significantly lower ratio of OXT between the first postoperative day and the day of surgery (0.88 VS 1.68, p = 0.0162, IC:0.2979-0.2642) but a significantly higher ratio of OXT between the fourth and the first postoperative days (1.17 VS 0.53, p = 0.0006, IC:-2.109-0.6092). Moreover, normonatraemic patients that did not show normalization of OXT levels at day 4 after surgery tended to develop SIAD later on.
Taken together, these results show for the first time that OXT release might help predict AVP-D after TPS and differentiate it from other pathologies of water-sodium balance.
短暂性精氨酸加压素缺乏症（AVP-D），以前称为尿崩症，是经蝶窦垂体手术（TPS）的一种众所周知的并发症，迄今为止尚无明确的预测生物标志物，因此难以预测。虽然催产素（OXT）以前被认为是预测TPS后不适当利尿综合征（SIAD）相关低钠血症的一种可能的生物标志物，但其在AVP-D患者中的分泌情况仍知之甚少。因此，我们假设在AVP-D的情况下，OXT可能会有不同的分泌情况，这将支持其作为AVP-D早期生物标志物的潜力。此外，我们假设OXT的异常分泌可能会在后期出现，尤其是与SIAD相关时。
我们测量了67例连续接受TPS患者的OXT尿量，并比较了不同时间点之间的催产素值以及不同组之间的OXT比值。我们研究的主要终点是确定与血钠正常的患者相比，AVP-D患者的尿OXT排泄量是否存在差异。作为次要终点，我们比较了两组在AVP-D诊断后OXT分泌的变化情况，比较了后来发生SIAD的患者和未发生SIAD的患者。
发生AVP-D的患者在TPS后OXT分泌增加出现延迟，术后第一天与手术当天之间的OXT比值显著降低（0.88对1.68，p = 0.0162，IC：0.2979 - 0.2642），但术后第四天与第一天之间的OXT比值显著升高（1.17对0.53，p = 0.0006，IC：-2.109 - 0.6092）。此外，术后第4天OXT水平未恢复正常的血钠正常患者后期倾向于发生SIAD。
综上所述，这些结果首次表明，OXT释放可能有助于预测TPS后的AVP-D，并将其与其他水钠平衡病理状态区分开来。
