Skip to main content
SpringerLink
Log in

Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

To identify presurgical and surgical factors associated with the development of diabetes insipidus (DI) after pituitary adenoma (PA) resection through an endoscopic endonasal transsphenoidal approach.

Methods

Data from 231 patients with functioning and non-functioning PAs who underwent an endoscopic endonasal transsphenoidal approach in the last ten years.

Results

231 patients with 241 pituitary surgeries were included. Eighty-five percent harbored macroadenomas and 38.1% of them were invasive.

After pituitary surgery, 12.5% (n = 30) developed transient DI and 5.0% (n = 12) permanent DI. The global risk of DI was higher in patients younger than 65 years (OR = 2.94, p = 0.029), with total tumoral resection (OR = 2.86, p = 0.007) and with diaphragm opening during pituitary resection (OR = 3.63, p = 0.0003). Once postoperative DI developed, the risk of permanent DI increased in those patients with larger PA (OR = 1.07 for each mm of craniocaudal diameter, p = 0.020), especially in those greater than 30 mm (OR = 8.33, p = 0.004). Moreover, diaphragm opening during pituitary resection (OR = 28.3, p = 0.018) predicted long-term DI independently of pituitary tumor size. The risk of permanent DI increased as PA craniocaudal diameter increased (r = 0.20, p = 0.002).

Conclusion

In patients with PAs younger than 65 years, in whom diaphragm has been opened during pituitary surgery and/or with a total tumor resection, special hydric balance monitoring should be maintained in the postoperative period due to the increased risk of developing DI. The risk of permanent DI increases as PA craniocaudal diameter increased.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Adams JR, Blevins LS, Allen GS, Verity DK, Devin JK (2006) Disorders of water metabolism following transsphenoidal pituitary surgery: a single institution’s experience. Pituitary 9(2):93–99. https://doi.org/10.1007/s11102-006-9276-2

    Article  PubMed  Google Scholar 

  2. Nemergut EC, Zuo Z, Jane JA, Laws ER (2005) Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg 103(3):448–454. https://doi.org/10.3171/jns.2005.103.3.0448

    Article  PubMed  Google Scholar 

  3. Qari FA, AbuDaood EA, Nasser TA (2016) Diabetes insipidus following neurosurgery at a university hospital in Western Saudi Arabia. Saudi Med J 37(2):156–160. https://doi.org/10.15537/smj.2016.2.12848

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schreckinger M, Walker B, Knepper J, Hornyak M, Hong D, Kim JM et al (2013) Post-operative diabetes insipidus after endoscopic transsphenoidal surgery. Pituitary 16(4):445–451. https://doi.org/10.1007/s11102-012-0453-1

    Article  PubMed  Google Scholar 

  5. Devin JK (2012) Hypopituitarism and central diabetes insipidus. perioperative diagnosis and management. Neurosurg Clin N Am 23(4):679–689. https://doi.org/10.1016/j.nec.2012.06.001

    Article  PubMed  Google Scholar 

  6. Winzeler B, Zweifel C, Nigro N, Arici B, Bally Schuetz MP, Blum CA et al (2015) Postoperative copeptin concentration predicts diabetes insipidus after pituitary surgery. J Clin Endocrinol Metab 100(6):2275–2282. https://doi.org/10.1210/jc.2014-4527

    Article  CAS  PubMed  Google Scholar 

  7. Berton AM, Gatti F, Penner F, Varaldo E, Prencipe N, Rumbolo F et al (2020) Early copeptin determination allows prompt diagnosis of post-neurosurgical central diabetes insipidus. Neuroendocrinology 110(6):525–534. https://doi.org/10.1159/000503145

    Article  CAS  PubMed  Google Scholar 

  8. Araujo-Castro M, Pascual-Corrales E, Martínez San Millan JS, Rebolleda G, Pian H, Ruz-Caracuel I (2020) Postoperative management of patients with pituitary tumors submitted to pituitary surgery. experience of a spanish pituitary tumor center of excellence. Endocrine 69(1):5–17. https://doi.org/10.1007/s12020-020-02247-y

    Article  CAS  PubMed  Google Scholar 

  9. Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A et al (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99(11):3933–3951. https://doi.org/10.1210/jc.2014-2700

    Article  CAS  PubMed  Google Scholar 

  10. Nieman LK, Biller BMKK, Findling JW, Newell-Price J, Savage MO, Stewart PM et al (2008) The diagnosis of cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93(5):1526–1540. https://doi.org/10.1210/jc.2008-0125

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Beck-Peccoz P, Lania A, Beckers A, Chatterjee K, Wemeau J-L (2013) 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur Thyroid J 2(2):76–82. https://doi.org/10.1159/000351007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA et al (2011) Diagnosis and treatment of hyperprolactinemia: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(2):273–288. https://doi.org/10.1210/jc.2010-1692

    Article  CAS  PubMed  Google Scholar 

  13. Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33(4):610–617. https://doi.org/10.1227/00006123-199310000-00008 ((discussion 617-8))

    Article  CAS  PubMed  Google Scholar 

  14. Nayak P, Montaser AS, Hu J, Prevedello DM, Kirschner LS, Ghalib L (2018) Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas. J Endocr Soc 2(9):1010–1019. https://doi.org/10.1210/js.2018-00121

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Prete A, Corsello SM, Salvatori R (2017) Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab 8(3):33–48. https://doi.org/10.1177/2042018816687240

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cote DJ, Dasenbrock HH, Muskens IS, Broekman MLD, Zaidi HA, Dunn IF et al (2017) Readmission and other adverse events after transsphenoidal surgery: prevalence, timing, and predictive factors. J Am Coll Surg 224(5):971–979. https://doi.org/10.1016/j.jamcollsurg.2017.02.015

    Article  PubMed  Google Scholar 

  17. Yoon HK, Lee HC, Kim YH, Lim YJ, Park HP (2020) Predictive factors for delayed hyponatremia after endoscopic transsphenoidal surgery in patients with nonfunctioning pituitary tumors: a retrospective observational study. World Neurosurg 133:484. https://doi.org/10.1016/j.wneu.2019.09.146

    Article  PubMed  Google Scholar 

  18. Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M (1999) Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf) 50(4):431–439. https://doi.org/10.1046/j.1365-2265.1999.00666.x

    Article  CAS  Google Scholar 

  19. Kristof RA, Rother M, Neuloh G, Klingmüller D (2009) Incidence, clinical manifestations, and course of water and electrolyte metabolism disturbances following transsphenoidal pituitary adenoma surgery: a prospective observational study: clinical article. J Neurosurg 111(3):555–562. https://doi.org/10.3171/2008.9.JNS08191

    Article  PubMed  Google Scholar 

  20. Ajlan AM, Bin AS, Achrol AS, Aljamaan Y, Feroze AH, Katznelson L et al (2018) Diabetes insipidus following endoscopic transsphenoidal surgery for pituitary adenoma. J Neurol Surg B Skull Base 79(2):117–122. https://doi.org/10.1055/s-0037-1604363

    Article  PubMed  Google Scholar 

  21. Helderman JH, Vestal RE, Rowe JW, Tobin JD, Andres R, Robertson GL (1978) The response of arginine vasopressin to intravenous ethanol and hypertonic saline in man: the impact of aging. J Gerontol 33(1):39–47. https://doi.org/10.1093/geronj/33.1.39

    Article  CAS  PubMed  Google Scholar 

  22. Duggan J, Kilfeather S, Lightman SL, O’malley K (1993) The association of age with plasma arginine vasopressin and plasma osmolality. Age Ageing 22(5):332–336. https://doi.org/10.1093/ageing/22.5.332

    Article  CAS  PubMed  Google Scholar 

  23. Sigounas DG, Sharpless JL, Cheng DML, Johnson TG, Senior BA, Ewend MG (2008) Predictors and incidence of central diabetes insipidus after endoscopic pituitary surgery. Neurosurgery 62(1):71–78. https://doi.org/10.1227/01.NEU.0000311063.10745.D8 ((discussion 78-9))

    Article  PubMed  Google Scholar 

  24. Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N (2011) Diaphragma sellae: a surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg 75(2):286–293. https://doi.org/10.1016/j.wneu.2010.08.002

    Article  PubMed  Google Scholar 

  25. Duff JM, Meyer FB, Ilstrup DM, Laws ER, Schleck CD, Scheithauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46(2):291–302. https://doi.org/10.1097/00006123-200002000-00007

    Article  CAS  PubMed  Google Scholar 

  26. Schura S, Lasrya O, Tewfikc MA, Di Maio S (2020) Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery. Neurosurgery 20:1–7. https://doi.org/10.1016/j.inat.2019.100628

    Article  Google Scholar 

  27. Wei T, Zuyuan R, Changbao S, Renzhi W, Yi Y, Wenbin M (2003) Hyponatremia after transspheniodal surgery of pituitary adenoma. Chin Med Sci J 18(2):120–123

    PubMed  Google Scholar 

  28. Lobatto DJ, de Vries F, Zamanipoor Najafabadi AH, Pereira AM, Peul WC, Vliet Vlieland TPM et al (2018) Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review. Pituitary 21(1):84–97. https://doi.org/10.1007/s11102-017-0839-1

    Article  PubMed  Google Scholar 

  29. Burke WT, Cote DJ, Penn DL, Iuliano S, McMillen K, Laws ER (2020) Diabetes insipidus after endoscopic transsphenoidal surgery. Neurosurgery 5:nyaa148. https://doi.org/10.1093/neuros/nyaa148

    Article  Google Scholar 

Download references

Funding

This work has not received any financial support.

Author information

Authors and Affiliations

  1. Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Hospital Ramón Y Cajal (IRYCIS), Madrid, Spain

    M. Araujo-Castro

  2. Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Madrid, Spain

    F. Mariño-Sánchez

  3. Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    A. Acitores Cancela & V. Rodríguez Berrocal

  4. Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Hospital HM Puerta del Sur, Madrid, Spain

    A. García Fernández

  5. Pituitary Surgery Unit, Department of Neurosurgery, Hospital Universitario Puerta del Sur, Madrid, Spain

    S. García Duque & V. Rodríguez Berrocal

Authors
  1. M. Araujo-Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Mariño-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Acitores Cancela
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. García Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. García Duque
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Rodríguez Berrocal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Araujo-Castro.

Ethics declarations

Conflict of interest

The authors have no conflict of interest.

Ethical approval

All procedures performed in the participants of the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Araujo-Castro, M., Mariño-Sánchez, F., Acitores Cancela, A. et al. Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries. J Endocrinol Invest 44, 1457–1464 (2021). https://doi.org/10.1007/s40618-020-01448-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-020-01448-6

Keywords

Search

Navigation