Sane T, Rantakari K, Poranen A, Tähtelä R, Välimäki M, Pelkonen R
Third Department of Medicine, University Hospital, Helsinki, Finland.
J Clin Endocrinol Metab. 1994 Nov;79(5):1395-8. doi: 10.1210/jcem.79.5.7962334.
We studied the incidence of postoperative hyponatremia in 91 consecutive patients (44 males and 47 females; age, 45 yr; range, 12-76) operated on transsphenoidally for pituitary tumors. A postoperative serum sodium concentration less than 135 mmol/L (the lowest, 109 mmol/L) was observed in 32 (35%) patients. Hyponatremia occurred most commonly in patients operated on for Cushing's disease (11 of 18 patients; 61%). Hyponatremia was symptomatic in 18 (56%) of the patients. Neither the size nor the operability of the tumor or transient postoperative polyuria predicted the development of hyponatremia. Hyponatremia was first observed on the sixth or seventh postoperative day. The patients were treated with water restriction and by increasing the hydrocortisone replacement dose in the case of ACTH deficiency, and recovery took place, on the average, within 5 days. High urinary osmolality and plasma arginine vasopressin concentration during hyponatremia in a subgroup of study patients with these measurements indicated that inappropriate vasopressin secretion was involved in the pathogenesis of hyponatremia. In conclusion, postoperative hyponatremia after transsphenoidal surgery is common and may put the patients at increased risk of severe hyponatremic symptoms. Therefore, all patients should be screened for serum electrolytes for 1 week after transsphenoidal surgery.
我们对91例连续经蝶窦手术切除垂体瘤的患者（44例男性和47例女性；年龄45岁；范围12 - 76岁）术后低钠血症的发生率进行了研究。32例（35%）患者术后血清钠浓度低于135 mmol/L（最低为109 mmol/L）。低钠血症最常见于接受库欣病手术的患者（18例中有11例；61%）。18例（56%）患者出现低钠血症症状。肿瘤的大小、可切除性或术后短暂性多尿均不能预测低钠血症的发生。低钠血症最早在术后第六或第七天被发现。患者接受限水治疗，对于促肾上腺皮质激素缺乏的患者则增加氢化可的松替代剂量，平均5天内恢复。在一组进行了这些测量的研究患者中，低钠血症期间尿渗透压和血浆精氨酸加压素浓度升高表明，不适当的加压素分泌参与了低钠血症的发病机制。总之，经蝶窦手术后的术后低钠血症很常见，可能会增加患者出现严重低钠血症症状的风险。因此，所有患者在经蝶窦手术后1周都应进行血清电解质筛查。
