Postoperative Diabetes Insipidus and Hyponatremia in Children after Transsphenoidal Surgery for Adrenocorticotropin Hormone and Growth Hormone Secreting Adenomas - 31/01/18

Doi : 10.1016/j.jpeds.2017.11.042

Carolina Saldarriaga, MD ¹, Charlampos Lyssikatos, MD ¹, Elena Belyavskaya, MD ¹, Margaret Keil, PhD, CRNP ¹, Prashant Chittiboina, MD ², Ninet Sinaii, PhD, MPH ³, Constantine A. Stratakis, MD, DMSci ¹, Maya Lodish, MD, MHSc ^1,^*
¹ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
² National Institute of Neurological Disorders and Stroke, Bethesda, MD
³ Biostatistics and Clinical Epidemiology Service (BCES), National Institutes of Health, Bethesda, MD

^*Reprint requests: Maya Lodish, MD, MHSc, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 10 Center Dr, Rm 2-5142, Bethesda, MD 20892-1103.Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)National Institutes of Health10 Center Dr, Rm 2-5142BethesdaMD20892-1103

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Abstract

Objectives

To define the incidence and risk factors of postoperative sodium alterations in pediatric patients undergoing transsphenoidal surgery (TSS) for adrenocorticotropic hormone and growth hormone secreting pituitary adenomas.

Study design

We retrospectively reviewed 160 patients ≤18 years of age who had TSS for pituitary adenomas at our institution from 1999 to 2017. Variables included daily serum sodium through postoperative day 10, urine specific gravity, and medications administered. We examined associations between sex, repeat surgery, manipulation of the posterior pituitary (PP), tumor invasion into the PP, tumor type and size, cerebrospinal fluid (CSF) leak, lumbar drain insertion, body mass index, puberty, and development of diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Results

Mean age was 12.9 ± 3.4 years (female = 81). Patients had adrenocorticotropic hormone (150/160) and growth hormone (10/160) producing adenomas. Forty-two (26%) patients developed DI. Among the 37 of 160 who required desmopressin acutely, 13 of 37 required it long term. Risk of long-term need for desmopressin was significantly higher in patients who had CSF leak 9 of 48 (P = .003), lumbar drain 6 of 30 (P = .019), manipulation 11 of 50 (P < .001), or invasion 4 of 15 (P = .022) of the PP. Sixty patients developed hyponatremia, 19 because of SIADH, 39 to hypotonic fluids and 2 to cerebral salt wasting syndrome. Patients with SIADH were placed on fluid restriction; 1 received salt tablets.

Conclusions

Among 160 children who underwent TSS for pituitary adenomas, the incidence of DI and SIADH after TSS was 26% and 14%, respectively. Combined risk factors for DI and/or SIADH include female sex, manipulation of and/or tumor invasion into the PP, and CSF leak or lumbar drain.

Trial registration

ClinicalTrials.gov: NCT00001595 and NCT00060541.

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Keywords : pituitary surgery, brain tumor, sodium abnormalities

Abbreviations : ACTH, ADH, BMI, CSF, CSW, DI, GH, NIH, PP, RR, SIADH, TSS

Plan

	Funded by the intramural programs of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Z01 HD008920), and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. The authors declare no conflicts of interest.
	Portions of this study were presented at the 10th Annual Meeting of the Pediatric Endocrine Society, September 14-17, 2017, Washington, D.C.