Cephalocaudal tumor diameter is a predictor of diabetes insipidus after endoscopic transsphenoidal surgery for non-funct
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Cephalocaudal tumor diameter is a predictor of diabetes insipidus after endoscopic transsphenoidal surgery for non‑functioning pituitary adenoma Hyongmin Oh1 · Hyeon Cheun1 · Yoon Jung Kim1 · Hyun‑Kyu Yoon1 · Ho Kang2 · Hyung‑Chul Lee1 · Hee‑Pyoung Park1 · Jung Hee Kim3,4 · Yong Hwy Kim2,4 Accepted: 4 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Diabetes insipidus (DI) develops commonly after endoscopic transsphenoidal surgery (ETS). We retrospectively investigated the incidence, onset, duration and predictors of DI after ETS in patients with non-functioning pituitary adenoma (NFPA). Methods A total of 168 patients who underwent ETS to remove NFPAs were included. Various perioperative data on demographics, comorbidities, previous treatments, perioperative hormone deficiencies, tumor characteristics, surgery, anesthesia, intraoperative fluid balance, perioperative laboratory findings, postoperative complications, readmission and hospital length of stay were collected and analyzed. Patients were diagnosed with DI and treated with desmopressin when they showed urine output > 5 mL/kg/hr with a serum sodium concentration > 145 mmol/L or an increase ≥ 3 mmol/L in serum sodium concentration between two consecutive tests after surgery. DI was considered permanent when desmopressin was prescribed for > 6 months after surgery. Results Seventy-seven (45.8%) patients experienced postoperative DI and 10 (6.0%) patients suffered from permanent DI. The median onset of DI and the median duration of transient DI were postoperative day 1 and 5 days, respectively. In multivariable logistic regression analysis, cephalocaudal tumor diameter (odds ratio [95% confidence interval] 2.59 [1.05–6.36], P = 0.038) was related to postoperative DI. In receiver operating characteristic analysis, its area under the curve was 0.68 (95% confidence interval 0.59–0.76, P 5 mL/kg/hr for 2 hours
Laboratory testsa
Serum Na+ ≤145 mmol/L and serum Na+ increase 145 mmol/L or serum Na+ increase ≥3 mmol/Lb
Urine ≤5 mL/kg/hr for 1 hour
Urine >5 mL/kg/hr for 1 hour
Observation
Laboratory testsa
Serum Na+ ≤145 mmol/L and serum Na+ increase 5 mL/kg/hr) with either a high serum sodium concentration (> 145 mmol/L) or a large increase (≥ 3 mmol/L) in serum sodium concentration between two consecutive tests after surgery (Fig. 1). DI included both transient and permanent DI, which were divided according to whether desmopressin was prescribed for more than six months after surgery [7, 8]. The duration of transient DI was defined as the period between the date of diagnosis and the date of the last desmopressin prescription. Tests for the diagnosis of ACTH, TSH, GH, and gonadotropin deficiencies were performed in all patients before and three months after surgery. ACTH deficiency was defined as peak serum cortisol concentration below 18 μg/dL in the short ACTH test, serum cortisol concentration below 18 μg/L in the insulin‐induced hypoglycemia test, or morning serum cortisol concentration below 5 µg/dL
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