title: Post-operative hyponatremia in patients with pituitary adenoma: post-operative management with a uniform treatment protocol.
abstract: This study is a retrospective analysis of hyponatremia after transsphenoidal surgery in patients with pituitary adenoma. We evaluated (i) the incidence of post-operative hyponatremia (serum Na levels ≤ 135 mEq/L) and the emergence of hyponatremic symptoms, and assessed (ii) the risk factors under a uniform protocol of i.v. infusion with steroid and electrolyte fluid. We examined 88 consecutive operated patients (female: 60; male: 28) with pituitary adenoma. Apart from reconfirming the effects of the purported risk factors, we focused on the degree of serum Na decline on post-operative hyponatremia. Although remained stable during early post-operative period (4 days after surgery), the serum Na levels subsequently decreased after post-operative day 4 in 81 of 88 cases (92.0%). Of 88 patients, 27 (30.7%) and 9 (10.2%) cases suffered from hyponatremia, and developed hyponatremic symptoms. Interestingly, the degree of serum Na levels decline (from pre-operative levels) indicated a useful independent risk factor for monitoring hyponatremic symptoms (p = 0.006) and the degree of decline tended to be greater in elder patients (> 60 years) (p = 0.0346). Serum Na levels should be monitored from, at least, post-operative day 7 to detect early development of hyponatremia. Special attention and recovery effort should be given to elder patients with marked serum Na level decline after surgery.
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan. d055634@hiroshima-u.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tominaga
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Hanaya
authors.forename: Seiji
authors.initials: S
authors.lastname: Hama
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Sakoguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Usui
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000502:physiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001623:Betamethasone / Q000627:therapeutic use; D013507:Endocrine Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000502:physiology; D007010:Hyponatremia / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D013100:Sphenoid Bone / Q000601:surgery
chemical_list: D000324:Adrenocorticotropic Hormone; D001623:Betamethasone; D012964:Sodium; D006854:Hydrocortisone