Postoperative diabetes insipidus: how to define and grade this complication?
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Postoperative diabetes insipidus: how to define and grade this complication? Friso de Vries1,3 · Daniel J. Lobatto2,3 · Marco J. T. Verstegen2,3 · Wouter R. van Furth2,3 · Alberto M. Pereira1,3 · Nienke R. Biermasz1,3 Accepted: 9 September 2020 © The Author(s) 2020
Abstract Purpose Although transient diabetes insipidus (DI) is the most common complication of pituitary surgery, there is no consensus on its definition. Polyuria is the most overt symptoms of DI, but can also reflect several physiological adaptive mechanisms in the postoperative phase. These may be difficult to distinguish from and might coincide with DI. The difficulty to distinguish DI from other causes of postoperative polyuria might explain the high variation in incidence rates. This limits interpretation of outcomes, in particular complication rates between centers, and may lead to unnecessary treatment. Aim of this review is to determine a pathophysiologically sound and practical definition of DI for uniform outcome evaluations and treatment recommendations. Methods This study incorporates actual data and the experience of our center and combines this with a review of literature on pathophysiological mechanisms and definitions used in clinical studies reporting of postoperative DI. Results The occurrence of excessive thirst and/or hyperosmolality or hypernatremia are the best indicators to discriminate between pathophysiological symptoms and signs of DI and other causes. Urine osmolality distinguishes DI from osmotic diuresis. Conclusions To improve reliability and comparability we propose the following definition for postoperative DI: polyuria (urine production > 300 ml/hour for 3 h) accompanied by a urine specific gravity (USG) 300 mosmol/kg, or serum sodium > 145 mmol/L. To prevent unnecessary treatment with desmopressin, we present an algorithm for the diagnosis and treatment of postoperative DI. Keywords Diabetes insipidus · Fluid imbalance · Complications · Transsphenoidal surgery · Pituitary tumor · Vasopressin
Introduction Pituitary tumors require specialized care in particular for surgical management [26]. Centralization of care for patients with a pituitary tumor in Pituitary Centers of Excellence * Friso de Vries [email protected] 1
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, Leiden, Postbox 9600, 2300 RC, The Netherlands
2
Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, Postbox 9600, 2300 RC Leiden, The Netherlands
3
Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, Postbox 9600, 2300 RC Leiden, The Netherlands
that deal with high surgical volumes and harbor multidisciplinary teams is advocated to minimize disease- and treatment-related morbidity [15]. Local audits within treatment facilities, but also comparison of treatment results and complications between centers, hold the promise for future quality assurance. Uniform application of the same definitions is mandatory to r
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