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Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: a systematic review and meta-analysis

Fountas, Athanasios, Coulden, Amy, Fernández-García, Silvia, Tsermoulas, Georgios, Allotey, John, Karavitaki, Niki·2024·European Journal of Endocrinology
DOI 10.1093/ejendo/lvae084
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Abstract

Objective: Central diabetes insipidus or vasopressin deficiency (AVP-D) is the most frequent water balance disorder after transsphenoidal surgery (TSS) with variable prevalence amongst studies. We aimed to determine rates of newly developed transient or permanent AVP-D in patients with pituitary tumours treated with TSS. Design and Methods: We performed systematic review of Medline, Embase, and Cochrane Library between January 1, 2000 and January 31, 2021 for studies reporting on outcomes for pituitary adenoma, craniopharyngioma, and Rathke's cleft cyst (RCC) after TSS and providing definition of post-operative AVP-D. We pooled the results as proportions with 95% confidence intervals (CIs) using Freeman-Tukey transformation random effects meta-analysis. Results: From 11 694 studies, 51 were included. Rates of transient or permanent AVP-D were: 17% (95% CI, 13-21) and 3% (95% CI, 2-5) in total group, 16% (95% CI, 12-21) and 2% (95% CI, 2-3) in pituitary adenomas, 31% (95% CI, 24-39) and 30% (95% CI, 22-39) in craniopharyngiomas, and 35% (95% CI, 16-57) and 14% (95% CI, 6-23) in RCCs, respectively. Based on diagnostic criteria, rates of transient or permanent AVP-D were: For hypotonic polyuria, 14% (95% CI, 8-22) and 3% (95% CI, 1-4), for hypotonic polyuria and hypernatraemia, 21% (95% CI, 13-29) and 5% (95% CI, 2-11), and for desmopressin administration, 22% (95% CI, 15-29) and 9% (95% CI, 0-30), respectively. Conclusions: Following TSS, a small proportion of patients with pituitary adenoma have permanent AVP-D (2%), but prevalence reaches 30% in ones with craniopharyngioma and 14% in those with RCC. Diagnostic criteria for post-operative AVP-D remain variable affecting reported rates of this condition.

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Metadata

Authors
Fountas, A., Coulden, A., Fernández-García, S., Tsermoulas, G., Allotey, J., & Karavitaki, N.
Affiliations
Institute of Metabolism and Systems Research, University of Birmingham , Birmingham B15 2TT , United Kingdom
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2024-07
Volume
191
Issue
1
Pages
S1-S13
ISSN
  • 0804-4643
  • 1479-683X
DOI
10.1093/ejendo/lvae084
Cited by
31
References
4
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor, 11 d)

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Fountas, A., Coulden, A., Fernández-García, S., Tsermoulas, G., Allotey, J., & Karavitaki, N. (2024). Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: a systematic review and meta-analysis. European Journal of Endocrinology. https://doi.org/10.1093/ejendo/lvae084

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