Water and electrolyte disorders at long-term post-treatment follow-up in paediatric patients with suprasellar tumours include unexpected persistent cerebral salt-wasting syndrome.
BACKGROUND
Patients with brain tumours have a high risk of water and electrolyte disorders (WED). Postsurgery diabetes insipidus (DI) may be transient or permanent, the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) are usually transient.


METHODS
Retrospective study, including patients with suprasellar tumours, treated at Hôpital Necker, Institut Gustave-Roussy or Institut Curie, in Île-de-France, between 2007 and 2011. WED were noted if they persisted >1 month after surgery.


RESULTS
159 patients were included, 54.1% girls, 43.9% boys. Tumour types were: glioma (43.4%), craniopharyngioma (43.4%), germinoma (11.3%), others (1.9%). Age at diagnosis was 7.1 ± 4.6 years. The median time from end of treatment was 1.9 (0-7.8) years. DI was the most frequent disorder after tumour treatment (50.3%) and was significantly associated with surgery (p < 0.001). Persistent CSWS was present in 3.6%, persistent SIADH in 1.3%. Two cases of hypernatraemia were due to adipsia. Thyrotropin deficiency after treatment was noted in 68.9% of patients tested, adrenocorticotropin deficiency in 66.2%.


CONCLUSIONS
Patients with suprasellar tumours have a high incidence of long-term WED, mainly DI. Assessment of thyrotroph and corticotroph function, and thirst sensation, is necessary to diagnose and manage these disorders correctly. CSWS may be persistent in few patients and requires special attention to prescribe the appropriate care.
Service d'Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
Laura
L
González Briceño
Jacques
J
Grill
Franck
F
Bourdeaut
François
F
Doz
Jacques
J
Beltrand
Imane
I
Benabbad
Laurence
L
Brugières
Christelle
C
Dufour
Dominique
D
Valteau-Couanet
Léa
L
Guerrini-Rousseau
Isabelle
I
Aerts
Daniel
D
Orbach
Claire
C
Alapetite
Dinane
D
Samara-Boustani
Graziella
G
Pinto
Albane
A
Simon
Philippe
P
Touraine
Christian
C
Sainte-Rose
Michel
M
Zerah
Stéphanie
S
Puget
Caroline
C
Elie
Michel
M
Polak
D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007223:Infant; D008297:Male; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D019282:Wasting Syndrome / Q000453:epidemiology* / Q000209:etiology; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology* / Q000209:etiology