Routine postoperative fluid restriction to prevent syndrome of inappropriate antidiuretic hormone secretion after transsphenoidal resection of pituitary adenoma

2021 ◽  
pp. 1-8
Author(s):  
M. Harrison Snyder ◽  
David T. Asuzu ◽  
Dawn E. Shaver ◽  
Mary Lee Vance ◽  
John A. Jane
Keyword(s):  
Pituitary Adenoma ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Pituitary Surgery ◽  
Fluid Restriction ◽  
Readmission Rates ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
History Of ◽  
Transsphenoidal Resection

OBJECTIVE Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma. METHODS In March 2018, routine postoperative fluid restriction to 1000 ml/day for 7 days was instituted for all patients who underwent surgery for pituitary adenoma. These patients were compared with patients who underwent surgery for pituitary adenoma between March 2016 and March 2018, prior to implementation of routine fluid restriction. Patients with preoperative history of diabetes insipidus (DI) or concern for postsurgical DI were excluded. Patients were followed by neuroendocrinologists and neurosurgeons, and sodium levels were checked between 7 and 10 days postoperatively. SIADH was defined by a serum sodium level less than 136 mmol/L, with or without symptoms within 10 days after surgery. Thirty-day readmission was recorded and reviewed to determine underlying reasons. RESULTS In total, 82 patients in the fluid-unrestricted cohort and 135 patients in the fluid-restricted cohort were analyzed. The patients in the fluid-restricted cohort had a significantly lower rate of postoperative SIADH than patients in the fluid-unrestricted cohort (5% vs 15%, adjusted OR [95% CI] 0.1 [0.0–0.6], p = 0.01). Higher BMI was associated with lower rate of postoperative SIADH (adjusted OR [95%] 0.9 [0.9–1.0], p = 0.03), whereas female sex was associated with higher rate of SIADH (adjusted OR [95% CI] 3.1 [1.1–9.8], p = 0.03). There was no difference in the 30-day readmission rates between patients in the fluid-unrestricted and fluid-restricted cohorts (4% vs 7%, adjusted OR [95% CI] 0.5 [0–5.1], p = 0.56). Thirty-day readmission was more likely for patients with history of hypertension (adjusted OR [95% CI] 5.7 [1.3–26.3], p = 0.02) and less likely for White patients (adjusted OR [95% CI] 0.3 [0.1–0.9], p = 0.04). CONCLUSIONS Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.

scholarly journals Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion

2011 ◽  
Vol 164 (5) ◽  
pp. 725-732 ◽  
Author(s):  
Joseph G Verbalis ◽  
Suzanne Adler ◽  
Robert W Schrier ◽  
Tomas Berl ◽  
Qiong Zhao ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Health Survey ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Efficacy And Safety ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Days Of Therapy ◽  
Positive Treatment Effect ◽  
Positive Treatment

ObjectiveTolvaptan, an oral antagonist of the vasopressin V2 receptor, has been found to improve hyponatremia in patients with mixed etiologies. This study analyzed a subgroup of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) to evaluate the efficacy and safety of tolvaptan in this group.Design and patientsHyponatremic patients in the SALT-1 and SALT-2 studies with a diagnosis of SIADH were identified based on clinical diagnosis by individual study investigators. Subjects were randomized to receive oral placebo (n=52) or tolvaptan 15 mg daily, with further titration to 30 and 60 mg daily, if necessary, based on the response of serum [Na+] (n=58).ResultsIn patients with SIADH, improvement in serum [Na+] was significantly greater (P<0.0001) with tolvaptan than placebo over the first 4 days of therapy as well as the entire 30-day study, with minimal side effects of increased thirst, dry mouth, and urination. Only 5.9% of tolvaptan-treated patients had overly rapid correction of hyponatremia as defined by current guidelines. After discontinuation of tolvaptan, serum [Na+] declined to values similar to placebo. A significant positive treatment effect favoring tolvaptan on the physical component, and a near-significant trend on the mental component, was found using the SF-12 Health Survey. Tolvaptan was associated with a significantly reduced incidence of fluid restriction.ConclusionsResults for the SIADH subgroup were analogous to those of the combined SALT population regarding efficacy and safety but demonstrated a greater improvement in the physical component of the SF-12 Health Survey than in the full mixed etiology SALT patient group.

scholarly journals Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine

Blood ◽  
1975 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
MJ Stuart ◽  
C Cuaso ◽  
M Miller ◽  
FA Oski
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Repeated Treatment ◽  
Acute Lymphatic Leukemia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Lymphatic Leukemia ◽  
Specific Radioimmunoassay ◽  
Repeated Use

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

PITUITARY ADENOMA ASSOCIATED WITH INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION

1974 ◽  
Vol 76 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Kamal C. Greiss ◽  
Arnold M. Moses ◽  
Dorothy T. Krieger
Keyword(s):  
Pituitary Adenoma ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Ethanol Ingestion ◽  
Water Load ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Antidiuretic Hormone Secretion ◽  
Chromophobe Adenoma ◽  
Suprasellar Extension

ABSTRACT A 50 year old male with a chromophobe adenoma with suprasellar extension manifested hyponatraemia, plasma hypoosmolality, renal salt wasting and inability to excrete dilute urine after a standard water load. The patient exhibited no evidence of thyroid or adrenal insufficiency. The inability to excrete a water load was not corrected by prior cortisone administration but was partially corrected after ethanol ingestion. A measurable inappropriate amount of arginine vasopressin was excreted in the presence of sustained hydration. It is suggested that inappropriate production of antidiuretic hormone either by the adenoma, or secondary to hypothalamic involvement by the suprasellar extension of the tumour was responsible for the observed findings.

scholarly journals Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Masanori Hasebe ◽  
Jun Shirakawa ◽  
Daisuke Miyashita ◽  
Rieko Kunishita ◽  
Mayu Kyohara ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Antidiuretic Hormone ◽  
Arginine Vasopressin ◽  
Hormone Secretion ◽  
Emission Tomography ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Positron Emission

Abstract Background Syndrome of inappropriate antidiuretic hormone secretion can be caused by arginine-vasopressin-producing tumors or enhanced arginine vasopressin secretion from the posterior pituitary gland due to central nervous system disorders and intrathoracic diseases. Case presentation A 53-year-old Asian man was hospitalized with complaints of tremor and hiccups. Laboratory examination revealed findings suggestive of hypotonic hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. The patient did not complain of headache or photophobia, and showed no signs of meningeal irritation. Positron emission tomography–computed tomography revealed 18F-fluoro-deoxy-glucose accumulation along the cervical spinal cord, based on which the patient was diagnosed as having aseptic meningitis. The hyponatremia was treated successfully by fluid restriction, and optimum plasma sodium concentration was maintained by tolvaptan administration. Conclusions This case underscores the need to consider the possibility of mild meningitis as the cause of syndrome of inappropriate antidiuretic hormone secretion in patients without other identifiable cause.

scholarly journals Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine

Blood ◽  
1975 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
MJ Stuart ◽  
C Cuaso ◽  
M Miller ◽  
FA Oski
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Repeated Treatment ◽  
Acute Lymphatic Leukemia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Lymphatic Leukemia ◽  
Specific Radioimmunoassay ◽  
Repeated Use

Abstract The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

scholarly journals Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Subsequent Central Diabetes Insipidus: A Rare Presentation of Pituitary Apoplexy

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
S. B. Smedegaard ◽  
J. O. Jørgensen ◽  
N. Rittig
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Pituitary Apoplexy ◽  
Hormone Secretion ◽  
Central Diabetes Insipidus ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Pituitary Dysfunction

Pituitary apoplexy (PA) is a rare endocrine emergency that occasionally presents with sodium disturbances. Here we present a rare case with a previously healthy 41-year-old female who presented with acute onset headache and nausea without visual impairment or overt pituitary dysfunction. Plasma sodium concentrations declined abruptly during the first two days of admission to a nadir of 111 mmol/l. Urine and blood chemistry were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Magnetic resonance imaging revealed recent bleeding into a pituitary cystic process. Hyponatremia was successfully corrected with fluid restriction and both visual function and anterior pituitary function remained intact. Subsequently, the patient developed central diabetes insipidus (CDI), which responded well to desmopressin substitution. To our knowledge, this is the first case of PA presenting predominantly with posterior pituitary dysfunction that transitioned from SIADH to permanent CDI.

Syndrome of Inappropriate Antidiuretic Hormone Secretion in a Cat

2010 ◽  
Vol 46 (6) ◽  
pp. 425-432 ◽  
Author(s):  
Kristin Cameron ◽  
Alexander Gallagher
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Clinical Signs ◽  
Urine Osmolality ◽  
Electrolyte Imbalance ◽  
Fluid Restriction ◽  
Severe Hyponatremia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Serum And Urine

A 3-year-old, spayed female, domestic shorthaired cat was presented for evaluation of liver disease. Following anesthesia, laparoscopy, and medical therapy, the cat developed severe hyponatremia that was unresponsive to fluid therapy. Further evaluation of serum and urine osmolality determined that the cat fulfilled the criteria for syndrome of inappropriate antidiuretic hormone secretion. Treatment with fluid restriction resulted in resolution of the hyponatremia and clinical signs associated with the electrolyte imbalance.

Suprasellar arachnoid cyst resulting in the syndrome of inappropriate antidiuretic hormone secretion

2010 ◽  
Vol 6 (5) ◽  
pp. 486-488 ◽  
Author(s):  
Alexandra D. Beier ◽  
Samuel H. Cheshier ◽  
Aabir Chakraborty ◽  
Peter Dirks
Keyword(s):  
Antidiuretic Hormone ◽  
Arachnoid Cyst ◽  
Pediatric Population ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Hypothalamic Pituitary Axis ◽  
Suprasellar Arachnoid Cyst ◽  
Cyst Fenestration

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is occasionally seen after hypothalamic injury or dysfunction, although it typically occurs in association with other endocrine disturbances. It is has never been described as a presenting feature of a suprasellar arachnoid cyst (SAC) in the pediatric population. The authors describe the case of an enlarging SAC resulting in SIADH as the only presenting feature, with an otherwise normal hypothalamic-pituitary axis. An SAC was diagnosed in utero in this 5-month-old girl who had a normal functioning hypothalamic-pituitary axis on presentation. Because of cyst enlargement and hydrocephalus, the patient was scheduled for surgery; however, preoperative labs revealed SIADH. After stabilizing the serum sodium concentration with fluid restriction and the administration of 3% sodium chloride, the patient underwent endoscopic cyst fenestration. Postoperatively, she had complete resolution of the SIADH. Syndrome of inappropriate antidiuretic hormone secretion as the presenting symptom of an SAC has not been previously described. In the aforementioned patient, the proposed mechanism for SIADH was enlargement of the suprasellar arachnoid cyst causing compression of the supraoptic and paraventricular nuclei and thus overstimulating the secretion of arginine vasopressin, which resulted in SIADH. The association of SIADH with an SAC is reportable, as is the resolution of the SIADH via cyst fenestration. The authors suggest that SIADH is an uncommon presenting feature of SACs and that syndrome resolution is possible with cyst decompression.

scholarly journals SIADH in COVID 19 infection, an association or cause : A case report

2020 ◽  
Vol 8 (2) ◽  
pp. 126-128
Author(s):  
Karishma Shamarukh ◽  
Sharmin Rahman ◽  
Umme Kulsum Chy ◽  
Amina Sultana ◽  
Mohammad Omar Faruq
Keyword(s):  
Case Report ◽  
Antidiuretic Hormone ◽  
Hypertonic Saline ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Laboratory Parameters ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Low Sodium

One of the leading cause of hyponatremia is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Various etiologies of hyponatraemia have been observed till today but its association with Covid leading to SIADH is rare. Therefore, we present a case where SIADH was associated with Covid-19 pneumonia. This was a case of a 66 years old male with multiple co-morbidities presenting with symptoms of Covid infection including generalized weakness. After confirming Covid 19 infection management was started accordingly but patient’s weakness seemed to increase. He was found to have low sodium level of 105 mmol /L and investigations confirmed that he was having SIADH. He was treated with hypertonic saline, fluid restriction and his symptoms and laboratory parameters gradually improved. Bangladesh Crit Care J September 2020; 8(2): 126-128

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