Olson B R, Rubino D, Gumowski J, Oldfield E H
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
J Clin Endocrinol Metab. 1995 Jan;80(1):85-91. doi: 10.1210/jcem.80.1.7829644.
A retrospective analysis was performed to study the fluid and sodium status of patients undergoing transsphenoidal surgery (TS) for Cushing's disease. We evaluated the time of onset, duration, and relative incidence of isolated hyponatremia and identified possible factors associated with it. Of 58 patients that underwent TS over 1 yr, 52 without postoperative diabetes insipidus or volume depletion were studied. Isolated hyponatremia after TS for Cushing's disease occurred in 21%, and symptomatic hyponatremia (plasma sodium, < or = 125 mmol/L) with new onset headache, nausea, and emesis occurred in 7.0% of all operated. These later patients escaped monitoring and intervention for 24 h. The development of hyponatremia began early in the postoperative period and progressed slowly over 7 days. Maximum antidiuresis occurred on postoperative day 7. Vasopressin levels measured in two patients while hypoosmolar suggested that unregulated vasopressin release contributed to the hyponatremia. Cortisol levels, glucocorticoid replacement, and pituitary adenoma size were similar in normonatremic and hyponatremic patients. Patients combining a history of an estrogenic milieu and documented posterior pituitary trauma at surgery experienced lower nadir plasma sodium. All hyponatremic patients were fluid restricted, and none developed progressive neurological symptoms, morbidity, or mortality. We speculate that the mild degree and slow rate of development of hyponatremia and/or active monitoring and intervention contributed to the good outcome.
进行了一项回顾性分析，以研究因库欣病接受经蝶窦手术（TS）患者的液体和钠状态。我们评估了孤立性低钠血症的发病时间、持续时间和相对发生率，并确定了与之相关的可能因素。在1年多时间里接受TS手术的58例患者中，研究了52例无术后尿崩症或容量耗竭的患者。因库欣病接受TS手术后孤立性低钠血症的发生率为21%，所有手术患者中有7.0%出现有症状性低钠血症（血浆钠≤125 mmol/L），伴有新发头痛、恶心和呕吐。这些后期患者有24小时未得到监测和干预。低钠血症在术后早期开始出现，并在7天内缓慢进展。最大抗利尿作用出现在术后第7天。在两名患者低渗状态下测量的血管加压素水平表明，不受调节的血管加压素释放导致了低钠血症。血钠正常和低钠血症患者的皮质醇水平、糖皮质激素替代治疗及垂体腺瘤大小相似。有雌激素环境病史且手术中有垂体后叶创伤记录的患者，其最低血浆钠水平较低。所有低钠血症患者均限制液体摄入，且均未出现进行性神经症状、发病率或死亡率。我们推测，低钠血症的轻度程度和缓慢发展速度及/或积极的监测和干预促成了良好的结果。
