The management and outcome of hyponatraemia following transsphenoidal surgery: a retrospective observational study

• Published in: Acta neurochirurgica Vol. 164; no. 4; pp. 1135 - 1144
• Main Authors: Hussein, Ziad, Tzoulis, Ploutarchos, Marcus, Hani J., Grieve, Joan, Dorward, Neil, Bouloux, Pierre Marc, Baldeweg, Stephanie E.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.04.2022; Springer Nature B.V
• Subjects: Antidiuretic Hormone Receptor Antagonists - therapeutic use; Antidiuretics; Argipressin; Argipressin receptors; Female; Humans; Hyponatremia; Hyponatremia - epidemiology; Hyponatremia - etiology; Hyponatremia - therapy; Inappropriate ADH Syndrome - complications; Inappropriate ADH Syndrome - drug therapy; Interventional Radiology; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Neurosurgery general; Observational studies; Original - Neurosurgery general; Original Article - Neurosurgery general; Patients; Retrospective Studies; Risk groups; Sodium; Sodium - therapeutic use; Surgery; Surgical Orthopedics; Vasopressin; Hyponatraemia; Transsphenoidal surgery; Syndrome of Inappropriate ADH secretion; Pituitary adenoma
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-022-05134-9

Purpose Hyponatraemia is a common complication following transsphenoidal surgery. However, there is sparse data on its optimal management and impact on clinical outcomes. The aim of this study was to evaluate the management and outcome of hyponatraemia following transsphenoidal surgery. Methods A prospectively maintained database was searched over a 4-year period between January 2016 and December 2019, to identify all patients undergoing transsphenoidal surgery. A retrospective case-note review was performed to extract data on hyponatraemia management and outcome. Results Hyponatraemia occurred in 162 patients (162/670; 24.2%) with a median age of 56 years. Female gender and younger age were associated with hyponatraemia, with mean nadir sodium being 128.6 mmol/L on postoperative day 7. Hyponatraemic patients had longer hospital stay than normonatraemic group with nadir sodium being inversely associated with length of stay ( p  < 0.001). In patients with serum sodium ≤ 132 mmol/L, syndrome of inappropriate antidiuretic hormone secretion (SIADH) was the commonest cause (80/111; 72%). Among 76 patients treated with fluid restriction as a monotherapy, 25 patients (25/76; 32.9%) did not achieve a rise in sodium after 3 days of treatment. Readmission with hyponatraemia occurred in 11 cases (11/162; 6.8%) at a median interval of 9 days after operation. Conclusion Hyponatraemia is a relatively common occurrence following transsphenoidal surgery, is associated with longer hospital stay and risk of readmission and the effectiveness of fluid restriction is limited. These findings highlight the need for further studies to better identify and treat high-risk patients, including the use of arginine vasopressin receptor antagonists.