Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma.

Journal: Journal of neurological surgery. Part B, Skull base
Published Date: Feb 2, 2024

Abstract

 We aimed to determine the incidence and risk factors for development of diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) after transsphenoidal hypophysectomy (TSH) for resection of a pituitary adenoma.  This was a retrospective study of 403 adult patients undergoing TSH for pituitary adenoma. Clinical variables, tumor characteristics, and operative factors were collected. Incidences of DI and SIADH were determined, including timing in the perioperative period. Independent predictors of developing DI and SIADH were identified using multivariable logistic regression.  Following TSH, 21.3% of patients developed DI at a mean 2.6 days and 7.4% developed SIADH at a mean 4.7 days. DI was negatively associated with older age (odds ratio [OR] = 0.98, 95% confidence interval [CI]: 0.96-0.99,  = 0.029). DI was positively associated with female sex (OR = 2.26, 95% CI: 1.24-4.11,  = 0.008), increase in anteroposterior tumor size (OR = 1.54, 95% CI: 1.11-2.13,  = 0.010), intraoperative cerebrospinal fluid (CSF) leak (OR = 2.29, 95% CI: 1.25-4.19,  = 0.008), and every 100 mL of estimated blood loss (EBL) (OR = 1.18, 95% CI: 1.01-1.39,  = 0.046). Development of SIADH was positively associated with intraoperative CSF leak (OR = 3.56, 95% CI: 1.24-10.21,  = 0.018) on multivariate analysis.  DI and SIADH occur in the minority of patients undergoing TSH, but vigilance for their development must be maintained for days after the surgery. Development of DI after TSH is multifactorial, having possible patient-specific risk factors and risk related to the complexity of surgical dissection, reflected by tumor size, intraoperative CSF leak, and EBL. Development of SIADH could be associated with intraoperative CSF leak occurrence.

Authors

  • Gabrielle Petito
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Alex Hu
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Grace Zhang
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Susie Min
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Siddhant H Tripathi
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Adithya Kumar
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Geet Shukla
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Sanjit Shah
    Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Katie M Phillips
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Suman Jana
    Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Jonathan A Forbes
    Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Mario Zuccarello
    Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Norberto O Andaluz
    Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
  • Ahmad R Sedaghat
    Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.

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