Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsp
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ORIGINAL ARTICLE
Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries M. Araujo‑Castro1 · F. Mariño‑Sánchez2 · A. Acitores Cancela3 · A. García Fernández4 · S. García Duque5 · V. Rodríguez Berrocal3,5 Received: 2 September 2020 / Accepted: 7 October 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Purpose To identify presurgical and surgical factors associated with the development of diabetes insipidus (DI) after pituitary adenoma (PA) resection through an endoscopic endonasal transsphenoidal approach. Methods Data from 231 patients with functioning and non-functioning PAs who underwent an endoscopic endonasal transsphenoidal approach in the last ten years. Results 231 patients with 241 pituitary surgeries were included. Eighty-five percent harbored macroadenomas and 38.1% of them were invasive. After pituitary surgery, 12.5% (n = 30) developed transient DI and 5.0% (n = 12) permanent DI. The global risk of DI was higher in patients younger than 65 years (OR = 2.94, p = 0.029), with total tumoral resection (OR = 2.86, p = 0.007) and with diaphragm opening during pituitary resection (OR = 3.63, p = 0.0003). Once postoperative DI developed, the risk of permanent DI increased in those patients with larger PA (OR = 1.07 for each mm of craniocaudal diameter, p = 0.020), especially in those greater than 30 mm (OR = 8.33, p = 0.004). Moreover, diaphragm opening during pituitary resection (OR = 28.3, p = 0.018) predicted long-term DI independently of pituitary tumor size. The risk of permanent DI increased as PA craniocaudal diameter increased (r = 0.20, p = 0.002). Conclusion In patients with PAs younger than 65 years, in whom diaphragm has been opened during pituitary surgery and/ or with a total tumor resection, special hydric balance monitoring should be maintained in the postoperative period due to the increased risk of developing DI. The risk of permanent DI increases as PA craniocaudal diameter increased. Keywords Pituitary adenomas · Pituitary surgery · Diabetes insipidus · Tumor size
* M. Araujo‑Castro [email protected] 1
Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Hospital Ramón Y Cajal (IRYCIS), Madrid, Spain
2
Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Madrid, Spain
3
Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
4
Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Hospital HM Puerta del Sur, Madrid, Spain
5
Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Puerta del Sur, Madrid, Spain
Introduction Diabetes insipidus (DI) is a common complication of transsphenoidal pituitary adenoma (PA) surgery. Surgical manipulation in the areas of the posterior pituitary, pituitary stalk, hypothalamus, and infundibu
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