Cited by 313Pituitary Gland Disorders and TreatmentsElectrolyte and hormonal disordersHead and Neck Surgical Oncology

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Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients

Nemergut, Edward C., Zuo, Zhiyi, Jane, John A., Laws, Edward R.·2005·Journal of neurosurgery

DOI 10.3171/jns.2005.103.3.0448

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Abstract

OBJECT: Diabetes insipidus (DI) is a common complication of transsphenoidal surgery. The purpose of this study was to elucidate patient- and surgery-specific risk factors for DI. METHODS: The perioperative records of 881 patients who had undergone transsphenoidal microsurgery at the authors' institution between January 1995 and June 2001 were reviewed. Among 857 patients without preoperative DI, the overall incidence of immediate postoperative DI was 18.3%, with 12.4% of patients requiring treatment with desmopressin at some point during their hospitalization. Persistent DI requiring long-term treatment with desmopressin was noted in 2% of all patients. An observable intraoperative cerebrospinal fluid (CSF) leak was strongly associated with an increased incidence of both transient (33.3%) and persistent (4.4%) DI. Craniopharyngioma and Rathke cleft cyst (RCC) were also associated with an increased incidence of transient and persistent DI, whereas repeated operation was not. Among patients with pituitary adenomas, those with Cushing's disease had an increased risk of transient (22.2%), but not persistent, DI. Patients with a microadenoma were more likely to suffer transient DI than those harboring a macroadenoma (21.6 compared with 14.3%) but were not more likely to experience persistent DI. CONCLUSIONS: Diabetes insipidus remains a common complication of transsphenoidal surgery; however, it is most frequently transient in nature. Patients with an intraoperative CSF leak, a microadenoma, a craniopharyngioma, or an RCC appear to have an increased risk of transient DI. Risk factors for persistent DI include an intraoperative CSF leak, a craniopharyngioma, or an RCC.

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Background
Frequent Occurrence of the Triphasic Response (Diabetes Insipidus/Hyponatremia/Diabetes Insipidus) after Surgery for Craniopharyngioma in Childhood
Finken, M. J. J., Zwaveling‐Soonawala, N., Walenkamp, M. J. E., Vulsma, T., van Trotsenburg, A. S. P., & Rotteveel, J. (2011) · Hormone Research in Paediatrics · doi:10.1159/000324115 · Cited by 46
“Surgery in the sellar region is often accompanied by postoperative disturbances in water homeostasis due to manipulation of, or damage to, the neurohypophyseal system. After transsphenoidal surgery for various conditions, nearly 1 in 5 adult patients develops diabetes insipidus (DI), which is temporary in the majority…”
Background
Early Morning Cortisol Levels as Predictors of Short-Term and Long-Term Adrenal Function After Endonasal Transsphenoidal Surgery for Pituitary Adenomas and Rathke’s Cleft Cysts
McLaughlin, N., Cohan, P., Barnett, P. S., Eisenberg, A., Chaloner, C., & Kelly, D. F. (2012) · World Neurosurgery · doi:10.1016/j.wneu.2012.07.034 · Cited by 44
Postoperative Nausea and Vomiting and Pain After Transsphenoidal Surgery: A Review of 877 Patients
Flynn, B. C., & Nemergut, E. C. (2006) · Anesthesia & Analgesia · doi:10.1213/01.ane.0000221185.08155.80 · Cited by 43
“to the posterior pituitary or impair release of ADH from the posterior pituitary (19).”
BackgroundInfluential
Management of Diabetes Insipidus following Surgery for Pituitary and Suprasellar Tumors
Almalki, M., Ahmad, M. M., Brema, I. A., Almehthel, M. S., Aldahmani, K. M., Mahzari, M. M., & Beshyah, S. (2021) · Sultan Qaboos University medical journal · doi:10.18295/squmj.4.2021.010 · Cited by 42
Prognostic factors for impaired plasma sodium homeostasis after transsphenoidal surgery
Staiger, R. D., Sarnthein, J., Wiesli, P., Schmid, C., & Bernays, R. L. (2012) · British Journal of Neurosurgery · doi:10.3109/02688697.2012.714013 · Cited by 41
“Disturbance of the posterior pituitary gland interferes with antidiuretic hormone (ADH) secretion, resulting in central diabetes insipidus (DI) or the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (2-4).”
BackgroundInfluential
Central Diabetes Insipidus in Infancy With or Without Hypothalamic Adipsic Hypernatremia Syndrome: Early Identification and Outcome
Djermane, A., Elmaleh, M., Simon, D., Poidvin, A., Carel, J., & Léger, J. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-3108 · Cited by 41
Diabetes Insipidus: New Concepts for Diagnosis
Christ‐Crain, M. (2020) · Neuroendocrinology · doi:10.1159/000505548 · Cited by 41
Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence
Araujo-Castro, M., Pascual-Corrales, E., Millán, J., Rebolleda, G., Pián, H., Ruz-Caracuel, I., Granados, G. D. L. S., Urzaiz, L. L., Escobar-Morreale, H., & Berrocal, V. R. (2020) · Endocrine · doi:10.1007/s12020-020-02247-y · Cited by 39
Guía práctica de diagnóstico y tratamiento de la acromegalia
Cordido, F., Arnés, J. A. G., Marazuela, M., & Vela, E. T. (2013) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2013.01.012 · Cited by 39
Rathke’s Cleft Cysts
Kanter, A. S., Sansur, C. A., Jane, J. A., & Laws, E. R. (2006) · KARGER eBooks · doi:10.1159/000091579 · Cited by 39
Neuroimaging of central diabetes insipidus—when, how and findings
Adams, N., Farrell, T. P., O’Shea, A., O’Hare, A., Thornton, J., Power, S., Brennan, P., & Looby, S. T. (2018) · Neuroradiology · doi:10.1007/s00234-018-2072-7 · Cited by 38
Subclinical diabetes insipidus
Bellastella, A., Bizzarro, A., Colella, C., Bellastella, G., Sinisi, A. A., & Bellis, A. D. (2012) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2011.11.008 · Cited by 38
Perioperative Management of a Patient With Cushing Disease
Varlamov, E. V., Vila, G., & Fleseriu, M. (2022) · Journal of the Endocrine Society · doi:10.1210/jendso/bvac010 · Cited by 37
“Few studies have demonstrated a higher occurrence of postoperative DI in CD patients, attributing it to more extensive exploratory surgery and repeated surgery [107, 119].”
Background
Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries
Castro, M. A., Mariño‐Sánchez, F., Cancela, A. A., Fernández, A. G., Duque, S. G., & Berrocal, V. R. (2020) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01448-6 · Cited by 37
Hyponatraemia and hypernatraemia: Disorders of Water Balance in Neurosurgery
Castle‐Kirszbaum, M., Kyi, M., Wright, C. A., Goldschlager, T., Danks, R. A., & Parkin, W. G. (2021) · Neurosurgical Review · doi:10.1007/s10143-020-01450-9 · Cited by 37
“Damage to 80–90% of hypothalamic magnocellular neurons is necessary before symptoms arise [54]; transient DI and permanent DI are seen after 10-20% and 2% of pituitary surgeries, respectively [55, 99].”
Background
Tolvaptan, a Selective Oral Vasopressin V2-Receptor Antagonist, for Hyponatremia
Molitch, M. E. (2007) · Yearbook of Endocrinology · doi:10.1016/s0084-3741(08)70239-7 · Cited by 36
Physiologic Mechanisms of Water and Electrolyte Disturbances After Transsphenoidal Pituitary Surgery
Blair, E. T., Clemmer, J. S., Harkey, H. L., Hester, R. L., & Pruett, W. A. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.07.175 · Cited by 34
MRI–Negative Cushing's Disease: A Review on Therapeutic Management
Sabahi, M., Shahbazi, T., Maroufi, S. F., Vidal, K., Recinos, P. F., Kshettry, V. R., Röser, F., Adada, B., & Borghei-Razavi, H. (2022) · World Neurosurgery · doi:10.1016/j.wneu.2022.03.076 · Cited by 33
Transsphenoidal Surgery of Giant Pituitary Adenoma: Results and Experience of 239 Cases in A Single Center
Chen, Y., Xu, X., Cao, J., Jie, Y., Wang, L., Cai, F., Chen, S., Yan, W. X., Hong, Y., Zhang, J., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.879702 · Cited by 33
Disorders of Salt and Water Balance After Pituitary Surgery
Brooks, E., & Inder, W. J. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac622 · Cited by 35
Clinical characteristics and outcomes in elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary adenoma
Pereira, M. P., Oh, T., Joshi, R. S., Haddad, A. F., Pereira, K. M., Osorio, R. C., Donohue, K. C., Peeran, Z., Sudhir, S., Jain, S., et al. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.7.focus20524 · Cited by 32
Diabetes insipidus after endoscopic transsphenoidal surgery: multicenter experience and development of the SALT score
Castle‐Kirszbaum, M., Fuller, P. J., Wang, Y. Y., King, J. A. J., & Goldschlager, T. (2021) · Pituitary · doi:10.1007/s11102-021-01159-y · Cited by 32
Transsphenoidal pseudocapsule-based extracapsular resection for pituitary adenomas
Qu, X., Yang, J., Sun, J., Mou, C., Wang, G., Han, T., Qu, Y., Wang, M., & Xu, G. (2011) · Acta Neurochirurgica · doi:10.1007/s00701-011-0961-1 · Cited by 32
“3%), both of which were in line with the previous reports ranging from 2 to 30% [3, 16, 25, 33].”
Result
Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery
Lamas, C., del Pozo, C., & Villabona, C. M. (2014) · Endocrinología y Nutrición (English Edition) · doi:10.1016/j.endoen.2014.03.010 · Cited by 32
“- Intraoperative cerebrospinal fluid fistula.(3,5) - Histological type: Rathke cleft cysts(3) and craniopharyngiomas.”
BackgroundInfluential
Water balance disorders after neurosurgery: the triphasic response revisited
Hoorn, E. J., & Zietse, R. (2009) · Clinical Kidney Journal · doi:10.1093/ndtplus/sfp117 · Cited by 31
“It has been difficult to identify patients at risk, but predisposing factors appear to relate both to the disease (macroadenoma [11], microadenoma, craniopharyngioma, Rathke cleft cyst [12]) and to the surgery (degree of manipulation [4], intraoperative cerebrospinal fluid leak [12]).”
Transsphenoidal Surgery for Pituitary Tumors and Other Sellar Masses
Owen, T. J., Martin, L. G., & Chen, A. V. (2017) · Veterinary Clinics of North America Small Animal Practice · doi:10.1016/j.cvsm.2017.08.006 · Cited by 31
“Efforts to completely remove dorsally located tumor tissue in animals with large pituitary tumors may also lead to damage to the pituitary stalk and cell bodies in the hypothalamic nuclei, leading to the development of permanent CDI.(20,76) The incidence of permanent CDI seems to be higher in dogs with a P/B ratio gre…”
Background
Clinical Predictors of Diabetes Insipidus After Transcranial Surgery for Pituitary Adenoma
Wang, S., Li, D., Ni, M., Jia, W., Zhang, Q., He, J., & Jia, G. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.01.075 · Cited by 30
A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism
Neto, L. V., Boguszewski, C. L., de Araújo, L. A., Bronstein, M. D., Miranda, P. A. C., Musolino, N. R. D. C., Naves, L. A., Vilar, L., Ribeiro‐Oliveira, A., & Gadelha, M. R. (2016) · Archives of Endocrinology and Metabolism · doi:10.1590/2359-3997000000179 · Cited by 29
Sodium and Water Imbalance After Sellar, Suprasellar, and Parasellar Surgery
Kiran, Z., Sheikh, A., Momin, S. N. A., Majeed, I., Awan, S., Rashid, O., & Islam, N. (2016) · Endocrine Practice · doi:10.4158/ep161616.or · Cited by 29
“tumor type (more common with craniopharyngioma and Rathke’s cleft cyst) (5,22).”
Background
Sodium Perturbations After Pituitary Surgery
Yuen, K. C. J., Ajmal, A., Correa, R. R., & Little, A. S. (2019) · Neurosurgery Clinics of North America · doi:10.1016/j.nec.2019.05.011 · Cited by 28
Recurrent Rathke's Cleft Cysts: Incidence and Surgical Management in a Tertiary Pituitary Center over 2 Decades
Wedemeyer, M. A., Lin, M. P., Fredrickson, V. L., Arakelyan, A., Bradley, D., Donoho, D. A., Hurth, K. M., Weiss, M. H., Carmichael, J. D., & Zada, G. (2018) · Operative Neurosurgery · doi:10.1093/ons/opy258 · Cited by 28
Evaluation of Complications and Costs During Overlapping Transsphenoidal Surgery in the Treatment of Pituitary Adenoma
Karsy, M. J., Bowers, C. A., Scoville, J. P., Kundu, B., Azab, M. A., Gee, J. M., Guan, J., & Couldwell, W. T. (2018) · Neurosurgery · doi:10.1093/neuros/nyy269 · Cited by 27
A novel method for managing water and electrolyte balance after transsphenoidal surgery: preliminary study of moderate water intake restriction.
Takeuchi, K., Nagatani, T., Okumura, E., & Wakabayashi, T. (2014) · Europe PMC (PubMed Central) · doi:10.18999/nagjms.76.1-2.73 · Cited by 27
Diabetes insipidus secondary to sellar/parasellar lesions
Angelousi, A. G., Mytareli, C., Xekouki, P., Kassi, E. N., Barkas, K., Grossman, A. B., & Kaltsas, G. (2021) · Journal of Neuroendocrinology · doi:10.1111/jne.12954 · Cited by 26
Complications Associated With Transsphenoidal Pituitary Surgery
Agam, M., & Zada, G. (2018) · Neurosurgery · doi:10.1093/neuros/nyy160 · Cited by 25
Predictive factors of postoperative diabetes insipidus in 333 patients undergoing transsphenoidal surgery for non-functioning pituitary adenoma
Kinoshita, Y., Taguchi, A., Tominaga, A., Sakoguchi, T., Arita, K., & Yamasaki, F. (2021) · Pituitary · doi:10.1007/s11102-021-01175-y · Cited by 25
Central diabetes insipidus (vasopressin deficiency) after surgery for pituitary tumours: a systematic review and meta-analysis
Fountas, A., Coulden, A., Fernández-García, S., Tsermoulas, G., Allotey, J., & Karavitaki, N. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae084 · Cited by 30

Authors: Nemergut, E. C., Zuo, Z., Jane, J. A., & Laws, E. R.
Affiliations: University of Virginia Health System (US)
ORCID: Zuo, Zhiyi
Jane, John A.
Laws, Edward R.
Venue: Journal of neurosurgery
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Published: 2005-09
Volume: 103
Issue: 3
Pages: 448-454
ISSN: 0022-3085 (ISSN-L)
DOI: 10.3171/jns.2005.103.3.0448
OpenAlex: W2141699689
Cited by: 313
References: 34
Citations by year: 2026: 7 · 2025: 18 · 2024: 21 · 2023: 21 · 2022: 26 · 2021: 22 · 2020: 17 · 2019: 15 · 2018: 16 · 2017: 20 · 2016: 10 · 2015: 24 · 2014: 8 · 2013: 14 · 2012: 14
FWCI: 5.59
Type: journal article
Language: en
Open access: closed
Locations: Journal of neurosurgery (publishedVersion)
PubMed (publishedVersion)
Funders: University of Virginia
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Health Sciences › Medicine › Nephrology › Electrolyte and hormonal disorders
Health Sciences › Medicine › Surgery › Head and Neck Surgical Oncology
Keywords: diabetes insipidus, transsphenoidal surgery, postoperative complications, risk factors, desmopressin, cerebrospinal fluid leak, craniopharyngioma, Rathke's cleft cyst, pituitary adenoma, Cushing's disease, pituitary microadenoma, macroadenoma
MeSH terms: Adenoma, Craniopharyngioma, Diabetes Insipidus, Humans, Pituitary Neoplasms, Prognosis, Retrospective Studies, Sphenoid Sinus, Subdural Effusion, Incidence, Central Nervous System Cysts

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Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients

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