Diabetes Insipidus After Endoscopic Transsphenoidal Surgery. Issue 5 (November 2020)

• Record Type: Journal Article
• Authors: Burke, William T; Cote, David J; Penn, David L; Iuliano, Sherry; McMillen, Katie; Laws, Edward R
• Is Part Of: Neurosurgery. Volume 87:Issue 5(2020)
• Publication Date: 2020-11
• Subjects: Craniopharyngioma -- Desmopressin (dDAVP) -- Diabetes insipidus -- Pituitary adenoma -- Rathke cleft cyst -- Transsphenoidal surgery; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa148
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND: : Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors. OBJECTIVE: : To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI. METHODS: : A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow‐up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow‐up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI. RESULTS: : The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow‐up was 10.7 mo (range: 0.2‐136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2‐3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9‐16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8‐20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9‐72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA. CONCLUSION: : Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.