title: Incidence, predictors and early post-operative course of diabetes insipidus in paediatric craniopharygioma: a comparison with adults.
abstract: OBJECTIVE
  This study aims to determine the incidence, predictors, early post-operative course of diabetes insipidus (DI) in paediatric craniopharyngiomas(CP) and compare the findings with adults.
  
  
  METHODS
  Retrospective analysis of clinical, biochemical, radiological and operative data for 102 consecutive CP surgeries (45 paediatric and 57 adult cases) was done. Bivariate and multivariate analyses were done to determine the predictors of DI. The incidence of the triphasic response and electrolyte abnormalities in the first post-operative week was compared between children and adults.
  
  
  RESULTS
  Children had larger tumours and higher incidence of cystic tumours and hydrocephalus. Preoperative DI was close to 15 % in both the age groups. Radical/subtotal excision was achieved in 58 % of children and 53 % of adults. The incidence of post-operative DI was 80 % and 63 % in children and adults, respectively. Children had significantly higher incidence of permanent DI (55.6 %). Radical excision in children (p = 0.000); previous tumour surgery (p = 0.014) and new onset hypopituitarism (p = 0.019) in adults were associated with permanent DI. The triphasic response (23 %), wide intra-day serum sodium fluctuations and hyponatraemia were more common in children.
  
  
  CONCLUSIONS
  Post-operative DI is a frequent and significant cause of morbidity in children undergoing surgery for CP. Children have a higher incidence of permanent DI. Radical excision is a predictor of permanent DI in children, whereas previous tumour excision and new onset hypopituitarism were predictors of permanent DI among adults. The management of post-operative DI is more difficult in children and the treating physician needs to be alert to detect the triphasic response.
authors: Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors: Ravindran
authors: R
authors: Pratheesh
authors: Diane Margaret A
authors: DM
authors: Swallow
authors: Simon
authors: S
authors: Rajaratnam
authors: K S
authors: KS
authors: Jacob
authors: Geeta
authors: G
authors: Chacko
authors: Mathew
authors: M
authors: Joseph
authors: Ari G
authors: AG
authors: Chacko
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D003919:Diabetes Insipidus / Q000453:epidemiology* / Q000209:etiology*; D004573:Electrolytes / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D004573:Electrolytes
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