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Article Abstract
Objective: The goal of this study was to characterize the pre-, peri-, and postoperative risk factors associated with early hyponatremia (defined as a serum sodium level < 135 mEq/L on or before postoperative day [POD] 3) following transsphenoidal pituitary surgery.
Methods: This retrospective study was performed using a single-institution database for patients undergoing surgery for pituitary adenoma (PA). Serum values were collected routinely throughout the postoperative period. Uni- and multivariable statistical analyses were performed to identify independent predictors of early hyponatremia. Patients with diabetes insipidus receiving desmopressin were excluded from the analysis.
Results: Of 254 patients with nonfunctional PAs (NFPAs), 65 (25.6%) developed early-onset hyponatremia. Univariable analysis showed that older age, higher preoperative serum sodium, higher preoperative serum glucose, BMI > 30 kg/m2, and pituitary apoplexy were significantly associated with early hyponatremia (p < 0.05). Multivariable logistic regression modeling revealed that the factors most strongly associated with early hyponatremia were thiazide diuretic use (OR 7.84, 95% CI 1.01-72.11; p = 0.049), pituitary apoplexy (OR 21.33, 95% CI 2.86-271.37; p = 0.006), preoperative glucose level (OR 1.16 per 10 mg/dl, 95% CI 1.02-1.36; p = 0.032), and BMI > 27 kg/m2 (OR 0.05, 95% CI 0.00-0.36; p = 0.010).
Conclusions: Early-onset hyponatremia is a common electrolyte derangement following transsphenoidal pituitary surgery for NFPAs. Clinical factors including low BMI, thiazide diuretic use, and elevated preoperative serum glucose were associated with an increased risk of early-onset hyponatremia. Higher BMI, in contrast, was protective against early-onset hyponatremia. Understanding the factors related to postoperative hyponatremia can aid in earlier detection, monitoring, and treatment for high-risk patients following PA surgery.
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| http://dx.doi.org/10.3171/2024.12.JNS241384 | DOI Listing |
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