The Limited Role of Hypocortisolism in the Development of Delayed Postoperative Hyponatremia After Pituitary Surgery
Authors' conclusion
Hypocortisolism does not appear to be the primary mechanism underlying DPH following pituitary surgery, as evidenced by the lack of temporal correlation. Advanced age and postoperative pneumocephalus emerge as key risk factors for DPH, supporting a multifactorial etiology. Although preoperative ACTH deficiency was linked to a higher incidence of DPH, preoperative cortisol replacement was not associated with protection.
Study context
- Population
- Patients undergoing fully endoscopic surgery for clinically non-functioning pituitary neuroendocrine tumors (Pit-NETs), 2021–2024
- Participants
- 261 patients
- Exposure
- Patients with vs without delayed postoperative hyponatremia
- Delayed postoperative hyponatremia (DPH)n = 54
- Outcome
- Incidence of DPH
- Follow-up
- through 3-month follow-up
Methodological detailspropensity-score matched comparison, multivariable logistic regression
- Propensity-score matched comparison
- Multivariable logistic regression
Main finding
As reported in the abstract
DPH
54 patients
20.7%
Symptomatic DPH, share of cohort
4.2%
Median time to nadir sodium
8 days
Median nadir sodium
129 mEq/L
Observational data: associations, not effects.
Further findings
Nadir cortisol (propensity-score matched) · lower with DPH, not significant · propensity score matched comparison
P = 0.29
Hypocortisolism during hyponatremic episodes (propensity-score matched) · more frequent with DPH, not significant · propensity score matched comparison
P = 0.52
Independent predictors of DPH (multivariate analysis)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Age > 60 years | 2.09 (1.11–3.96) | P = 0.023 | |
| Postoperative pneumocephalus | 3.28 (1.59–6.81) | P = 0.001 | |
| 0.10.31310Odds ratio (log scale) |
Serum cortisol
- Serum cortisol did not differ significantly between hyponatremia and non-hyponatremia groups
Preoperative cortisol replacement
- Preoperative cortisol replacement did not show a protective effect against DPH
Original publication
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