Early water intake restriction to prevent inappropriate antidiuretic hormone secretion following transsphenoidal surgery: low BMI predicts postoperative SIADH.

Abstract

OBJECTIVE:

The goals of this study were to assess the incidence of and risk factors for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients following transsphenoidal surgery (TSS), and to validate the effectiveness of early prophylactic restriction of water intake.

DESIGN:

Retrospective analysis was performed for 207 patients who had undergone TSS, including 156 patients not placed on early prophylactic water restriction. Sixty-four patients received treatment for SIADH.

METHODS:

We compared the incidence of SIADH between patients with and without early water intake restriction, and analyzed various risk factors for SIADH using statistical analyses.

RESULTS:

BMI was significantly lower for patients with SIADH than for those patients without SIADH. Statistical analysis revealed that the threshold BMI predicting SIADH was 26. Serum sodium levels on postoperative days 5-10 and daily urine volumes on postoperative days 5-10 were significantly lower in patients with SIADH than in those without SIADH. Postoperative body weight loss on days 6, 8, 10, and 11 was significantly higher in patients with SIADH. The incidence of SIADH after starting prophylactic water intake restriction (14%) was significantly lower than the rate before early water restriction (38%; P<0.05).

CONCLUSIONS:

SIADH is relatively common after TSS, and serum sodium concentrations and daily urine volumes should be carefully monitored. Patients with low preoperative BMI should be closely observed, as this represented a significant preoperative risk factor for SIADH. Early prophylactic water intake restriction appears effective at preventing postoperative SIADH.

• Authors: Junko Matsuyama, Hidetoshi Ikeda, Shunsuke Sato, Koh Yamamoto, Genichiro Ohashi, Kazuo Watanabe
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 171 Issue 6 Pg. 711-6 (Dec 2014) ISSN: 1479-683X [Electronic] England
• PMID: 25227132 (Publication Type: Journal Article)
• Copyright: © 2014 European Society of Endocrinology.

Topics

• Adenoma (diagnosis, epidemiology, surgery)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Body Mass Index
• Child
• Drinking
• Female
• Humans
• Inappropriate ADH Syndrome (diagnosis, epidemiology, etiology, prevention & control)
• Male
• Middle Aged
• Neurosurgical Procedures
• Pituitary Neoplasms (diagnosis, epidemiology, surgery)
• Postoperative Care (methods)
• Postoperative Complications (diagnosis, epidemiology, etiology, prevention & control)
• Prognosis
• Sphenoid Bone (surgery)
• Time Factors
• Water Deprivation (physiology)
• Young Adult