Management of Diabetes Insipidus following Surgery for Pituitary and Suprasellar Tumors

Central diabetes insipidus (CDI) is a common complication of pituitary surgery. However, it is most frequently transient. It is defined by the excretion of an abnormally large volume of dilute urine with increasing serum osmolality. The reported incidence of CDI after pituitary surgery is variable; ranging from 0-90 %. Large tumor size, gross total resection, and intraoperative cerebrospinal fluid (CSF) leak usually have an increased risk of CDI as also seen with craniopharyngioma and Rathke’s cleft cysts. It can be associated with high morbidities and mortality if not promptly recognized and treated on time. It is essential to rule out other causes of postoperative polyuria to avoid unnecessary pharmacotherapy and iatrogenic hyponatremia. Once the diagnosis of CDI is established, close monitoring is required to evaluate the response to treatment and to determine whether the CDI is transient or permanent. This review outlines the evaluation and management of patients with CDI after pituitary and suprasellar tumors surgery to help recognize the diagnosis, consider the differential diagnosis, initiate therapeutic interventions, guide monitoring, and long-term management. Keywords: Central diabetes insipidus (CDI), polydipsia, polyuria, pituitary adenoma, preoperative risk factor, and pituitary surgery, arginine vasopressin, desmopressin, and treatment.

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Early Copeptin Determination Allows Prompt Diagnosis of Post-Neurosurgical Central Diabetes Insipidus

Neuroendocrinology ◽

10.1159/000503145 ◽

2019 ◽

Vol 110 (6) ◽

pp. 525-534 ◽

Cited By ~ 5

Author(s):

Alessandro Maria Berton ◽

Filippo Gatti ◽

Federica Penner ◽

Emanuele Varaldo ◽

Nunzia Prencipe ◽

...

Keyword(s):

Diabetes Insipidus ◽

Surrogate Marker ◽

Pituitary Surgery ◽

Central Diabetes Insipidus ◽

Optimal Timing ◽

Vasopressin Release ◽

Biochemical Alterations ◽

Post Surgery ◽

Patients At Risk ◽

Pituitary Lesion

Introduction: Central diabetes insipidus (CDI) is a frequent complication of pituitary surgery, but its diagnosis lacks standardized criteria. Copeptin, a surrogate marker of arginine vasopressin release, is triggered by psycho-physical stresses such as pituitary surgery. Low postoperative copeptin could predict CDI onset. The aims of this study were the validation of copeptin as a predictor of post-neurosurgical CDI and the identification of the optimal timing for its determination. Methods: Sixty-six consecutive patients operated for a hypothalamic-pituitary lesion were evaluated. Copeptin was determined preoperatively and at 1, 6, 12, 24 and 48 h post-extubation. Fifty-eight patients were reassessed after 3–6 months post-surgery to confirm transient (3 cases) or permanent CDI (5 cases) diagnosis. Results: A marked copeptin peak was identified at 1 h after extubation, when a value below or equal to 12.8 pmol/L had a good accuracy in identifying CDI cases (AUC 0.866, 95% CI 0.751–0.941). Moreover, a copeptin peak above 4.2 pmol/L excluded permanent forms (AUC 1, 95% CI 0.629–1). Regression analysis identified copeptin as the only significant predictor of CDI (OR 0.86, 95% CI 0.75–0.98, p = 0.02). A copeptin T1/T0 ratio below or equal to 1.47 identified patients at risk of isolated biochemical alterations even in the absence of an overt CDI. Conclusions: A prompt increase of copeptin is expected at 1 h after extubation. The absence of this peak is a reliable predictor of post-neurosurgical CDI.

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Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

Journal of Enam Medical College ◽

10.3329/jemc.v3i1.13869 ◽

2013 ◽

Vol 3 (1) ◽

pp. 18-23

Author(s):

Shamsul Alam ◽

ATM Mosharef Hossain ◽

AN Wakil Uddin ◽

Tariqul Islam ◽

Rezaul Amin ◽

...

Keyword(s):

Pituitary Adenoma ◽

Diabetes Insipidus ◽

Pituitary Adenomas ◽

Pituitary Surgery ◽

Electrolyte Imbalance ◽

Csf Leak ◽

Endoscopic Endonasal ◽

Microscopic Surgery ◽

Subtotal Removal

Background: The use of endoscope for the management of pituitary adenoma is not new. The better magnification and illumination provided by the endoscope gives better outcome than microscopic pituitary surgery. Objective: To find out the benefits of endoscope in relation to microscopic surgery. Materials and Methods: We performed 45 cases of pituitary adenoma surgery by endoscopic endonasal approach from July 2008 to July 2010. Results: Forty five cases underwent endoscopic transsphenoidal approach. Gross total removal was done in 35 cases and subtotal removal was done in 10 cases. Residual tumours were seen in 10 cases (22%) in postoperative follow-up MRI scan. Visual improvement was satisfactory, and hormonal improvement of functional adenoma was nice. Postoperative visual acuity and visual field were improved in 75% cases. There were 37% cases of temporary diabetes insipidus and about 4.5% cases of permanent diabetes insipidus. The average duration of follow-up was 20 months. One patient required reexploration to correct visual deterioration in the immediate postoperative period. There were 4.5% cases of CSF leak and 6.6% mortality. Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. Conclusion: Endoscopic endonasal pituitary surgery now has become a gold standard surgery for most of the pituitary adenomas because of its better advantages in relation to microscopic surgery and less complications and less hospital stay. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13869 J Enam Med Col 2013; 3(1): 18-23

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Symptomatic Rathke's Cleft Cyst Coexisting with Central Diabetes Insipidus and Hypophysitis: Case Report.

Endocrine Journal ◽

10.1507/endocrj.46.187 ◽

1999 ◽

Vol 46 (1) ◽

pp. 187-192 ◽

Cited By ~ 44

Author(s):

SEIJI HAMA ◽

KAZUNORI ARITA ◽

ATSUSHI TOMINAGA ◽

MASAMI YOSHIKAWA ◽

KUNIKI EGUCHI ◽

...

Keyword(s):

Case Report ◽

Diabetes Insipidus ◽

Central Diabetes Insipidus ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Rathke's Cleft

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Hypothalamic Type of Hypopituitarism and Central Diabetes Insipidus Probably Linked to Rathke's Cleft Cyst

Internal Medicine ◽

10.2169/internalmedicine.54.3289 ◽

2015 ◽

Vol 54 (8) ◽

pp. 935-940

Author(s):

Tomoko Asano ◽

Hodaka Yamada ◽

Masashi Yoshida ◽

Atsushi Aoki ◽

Aki Ikoma ◽

...

Keyword(s):

Diabetes Insipidus ◽

Central Diabetes Insipidus ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Rathke's Cleft

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Predictors and Incidence of Central Diabetes Insipidus after Endoscopic Pituitary Surgery

Yearbook of Endocrinology ◽

10.1016/s0084-3741(08)79008-5 ◽

2008 ◽

Vol 2008 ◽

pp. 344-345

Author(s):

W. Ludlam

Keyword(s):

Diabetes Insipidus ◽

Pituitary Surgery ◽

Central Diabetes Insipidus

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Central diabetes insipidus after syndrome of inappropriate antidiuretic hormone secretion with severe hyponatremia in a patient with Rathke's cleft cyst

Internal Medicine ◽

10.2169/internalmedicine.6608-20 ◽

2021 ◽

Author(s):

Yudai Hinata ◽

Nobumasa Ohara ◽

Takeshi Komatsu ◽

Yuki Sakurai ◽

Yuichiro Yoneoka ◽

...

Keyword(s):

Diabetes Insipidus ◽

Antidiuretic Hormone ◽

Hormone Secretion ◽

Central Diabetes Insipidus ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Severe Hyponatremia ◽

Inappropriate Antidiuretic Hormone Secretion ◽

Antidiuretic Hormone Secretion ◽

Rathke's Cleft

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Changes in copeptin levels before and 3 months after transsphenoidal surgery according to the presence of postoperative central diabetes insipidus

Scientific Reports ◽

10.1038/s41598-021-95500-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoo Hyung Kim ◽

Yong Hwy Kim ◽

Young Soo Je ◽

Kyoung Ryul Lee ◽

Hwan Sub Lim ◽

...

Keyword(s):

Diabetes Insipidus ◽

Serum Sodium ◽

Transsphenoidal Surgery ◽

Pituitary Surgery ◽

Diagnostic Value ◽

Normal Serum ◽

Central Diabetes Insipidus ◽

Copeptin Level ◽

Percentage Difference ◽

Normal Serum Sodium

AbstractCopeptin levels reflect arginine vasopressin (AVP) release from the hypothalamus. Pituitary surgery often impairs AVP release and results in central diabetes insipidus (CDI). Here, we aimed to investigate how serum copeptin level changes 3 months after pituitary surgery and whether it has a diagnostic value for postoperative permanent CDI. Consecutive patients who underwent endoscopic transsphenoidal surgery at a single tertiary hospital were recruited. Serum copeptin levels were measured preoperatively and 3 months postoperatively. Among 88 patients, transient and permanent CDI occurred in 17 (19.3%) and 23 (26.1%), respectively. Three-month postoperative copeptin levels significantly declined from preoperative levels in permanent CDI group (P < 0.001, percentage difference = − 42.2%) and also in the transient CDI group (P = 0.002, − 27.2%). Three months postoperative copeptin level < 1.9 pmol/L under normal serum sodium levels was the optimal cutoff value for diagnosing permanent CDI with an accuracy of 81.8%, while 3-month postoperative copeptin level ≥ 3.5 pmol/L excluded the CDI with a negative predictive value of 100%. Conclusively, 3 months postoperative copeptin levels significantly decreased from preoperative levels in the transient CDI group as well as the permanent CDI group. Three-month postoperative copeptin levels ≥ 3.5 pmol/L under normal serum sodium levels may be diagnostic for excluding postoperative CDI.

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