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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Duff, J. M., Meyer, F. B., Ilstrup, D. M., Laws, E. R., Schleck, C. D., & Scheithauer, B. W. (2000) · Neurosurgery · doi:10.1097/00006123-200002000-00007 · Cited by 356
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“However, some of them attribute it to the operative difficulty in finding the adenoma, thus, leading to increased manipulation of the pituitary.(6,12) In contrast, we found that when combining patients who developed DI and SIADH the incidence was higher in patients with GH-producing adenomas.”
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“Additionally, the reported incidence of post-operative Arginine Vasopressin Deficiency (AVP-D), previously named Diabetes Insipidus, can be as high as 30% and approximately 2% for permanent AVP-D [39, 41].”
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“In humans, a risk factor for postoperative transient and permanent CDI is intraoperative cerebrospinal fluid (CSF) leak [26].”
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Relationship between postoperative hypothalamic injury and water and sodium disturbance in patients with craniopharyngioma: A retrospective study of 178 cases
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“Patients at high risk for development of DI include those with microadenomas, craniopharyngiomas, or intraoperative CSF leak [44].”
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Transsphenoidal surgery for Rathke’s cleft cyst can reduce headache severity and frequency
Coté, D. J., Besasie, B. D., Hulou, M. M., Yan, S. C., Smith, T. R., & Laws, E. R. (2015) · Pituitary · doi:10.1007/s11102-015-0686-x · Cited by 13
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Background
Serum copeptin levels at day two after pituitary surgery and ratio to baseline predict postoperative central diabetes insipidus
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Background
A Machine Learning–Based Prediction of Diabetes Insipidus in Patients Undergoing Endoscopic Transsphenoidal Surgery for Pituitary Adenoma
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“An intraoperative cerebrospinal fluid leak may simply be a marker for a more aggressive resection involving more stalk manipulation, and inflammatory process after the reconstruction of the sellae may also promote an increased risk of transient DI [18].”
Background
Correlation of Pituitary Descent and Diabetes Insipidus After Transsphenoidal Pituitary Macroadenoma Resection
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“Craniopharyngioma was excluded due to a high probability of postoperative diabetes insipidus [43,44].”
Background
The Clinical pattern of Diabetes Insipidus in a large university hospital in the Middle East
Babiker, A. M. I., Jurayyan, N. A. M. A., Al-Jurayyan, R. N. A., Al-Gadi, I., & Drop, S. L. S. (2015) · Journal of Tropical Pediatrics · doi:10.1093/tropej/fmu075 · Cited by 8
“MRI can facilitate the diagnosis of CDI [22–25].”
Background
Rational use of glucocorticoid during pituitary surgery--a pilot study.
Bhansali, A., Dutta, P. R., Bhat, M. H., Mukherjee, K. K., Rajput, R., & Bhadada, S. K. (2008) · PubMed · Cited by 8
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“Since it would not be possible for patients with DI to tolerate polyuria and polydipsia for a prolonged period of time without water and electrolyte imbalance, patients with prolongedDI duration would eventually require desmopressin regardless of their tolerability to large amounts of drinking and UOP (3).”
Background
Update in Cushing disease: What the neurosurgeon has to KNOW, on behalf of the EANS skull base section
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Importance of Intraoperative Factors in Postoperative Arginine Vasopressin Deficiency After Pituitary Adenoma Surgery
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Utility of copeptin in predicting non-pathological postoperative polyuria in patients affected by acromegaly undergoing pituitary neurosurgery
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“…in the presence of new onset hypotonic polyuria (USG < 1.005), u-Osm inappropriately low for p-Osm (u-Osm/p-Osm ratio < 2 in the presence of p-Osm > 295 mOsm/kg), with or without hypernatre-mia (s-Na > 145 mmol/L) [ 15, 23, 24 ] and by the need to administer 1-deamino-8-D-AVP (dDAVP) treatment.”
BackgroundInfluential
Vasopressin, Diabetes Insipidus, and the Syndrome of Inappropriate Antidiuresis
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Anesthesia and intensive care management of patients with brain tumors
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Morphological Classification of Pituitary Tumors With Suprasellar Extension
Sarkar, S., Corrales, C. E., Laws, E. R., & Smith, T. R. (2023) · Neurosurgery · doi:10.1227/neu.0000000000002786 · Cited by 5
Pituitary Apoplexy After Intravitreal Injection of Vascular Endothelial Growth Factor Inhibitor: A Novel Complication
Kistka, H. M., Turner, J. H., Devin, J. K., Chambless, L. B., & Kasl, R. A. (2015) · Journal of Neurological Surgery Reports · doi:10.1055/s-0035-1554909 · Cited by 5
Functioning Endocrine Outcome after Endoscopic Endonasal Transsellar Approach for Pituitary Neuroendocrine Tumors
Molteni, G., Caiazza, N., Fulco, G., Sacchetto, A., Gulino, A., & Marchioni, D. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12082986 · Cited by 5
“Furthermore, this finding could be predictive of permanent diabetes insipidus [39].”
Background
Predictive modeling of arginine vasopressin deficiency after transsphenoidal pituitary adenoma resection by using multiple machine learning algorithms
Chen, Y., Zhong, J., Li, H., Lin, K., Wei, L., & Wang, S. (2024) · Scientific Reports · doi:10.1038/s41598-024-72486-w · Cited by 5
“The incidence of AVP-D after pituitary adenoma surgery ranges from 9 to 22% 10 .”
Influential
Actualités autour de la prise en charge des diabètes insipides centraux
Lasolle, H., & Borson‐Chazot, F. (2016) · Annales d Endocrinologie · doi:10.1016/s0003-4266(17)30073-2 · Cited by 5
Assessment of the outcomes of the treatment of Cushing's disease in the hospitals of Castilla-La Mancha
Huguet, I., Aguirre, M., Vicente, A., Alramadán, M., Quiroga, I., Silva, J., & Lamas, C. (2015) · Endocrinología y Nutrición (English Edition) · doi:10.1016/j.endoen.2015.05.005 · Cited by 5
“Nemergut et al.(13) found a greater risk of transient (22%), but not permanent DI.”
Background
Análisis de los resultados del tratamiento de la enfermedad de Cushing en los hospitales de Castilla-La Mancha
Huguet, I., Aguirre, M., Vicente, A., Alramadán, M., Quiroga, I., Silva, J., & Lamas, C. (2015) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2015.02.007 · Cited by 5
Complications with Transsphenoidal Surgery: A Review
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Hypothalamus-Pituitary Dysfunction as an Independent Risk Factor for Postoperative Central Nervous System Infections in Patients With Sellar Region Tumors
Wen, J., Yin, R. M., Chen, Y., Chang, J., Ma, B., Zuo, W., Zhang, X., Ma, X., Feng, M., Wang, R., et al. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.661305 · Cited by 5
Capsule plication as a protective measure against post-operative intracapsular haematoma formation following trans-sphenoidal removal of pituitary macroadenoma
Kitano, M., & Taneda, M. (2008) · Acta Neurochirurgica · doi:10.1007/s00701-008-1583-0 · Cited by 5
Predictive factors for early-onset hyponatremia following endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas
Zeng, W., Prasad, A., Emeh, A., Gillespie, E., Perez, M., Coté, D. J., Briggs, R. G., Peterson, R., Shah, I., Gómez, D., et al. (2025) · Journal of neurosurgery · doi:10.3171/2024.12.jns241384 · Cited by 4
Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery
Sakata, K., Hashimoto, A., Takeshige, N., Orito, K., Nagayama, A., Ashida, K., Nomura, M., & Morioka, M. (2024) · Endocrine · doi:10.1007/s12020-024-03835-y · Cited by 4
Exploring factors behind Arginine-Vasopressine deficiency in endoscopic endonasal surgery for PitNET: a single-center analysis of 349 patients
Marco, R. D., Antico, A., Prencipe, N., Berton, A. M., Pesaresi, A., Perna, G. D., Portonero, I., Bue, E. L., Penner, F., Grottoli, S., et al. (2025) · Neurosurgical Review · doi:10.1007/s10143-025-03599-7 · Cited by 4
“…[ 9 ]: for example specific sellar/parasellar pathologies, such as craniopha - ryngioma (CP) and Rathke Cleft Cysts (RCC), due to their origin from Rathke’s pouch remnants are more often adher - ents to the pituitary stalk and neurohypophysis explaining an increased rate of AVP-D [ 7 , 23 , 32 ].”
Influential
Spontaneous Resolution of Diabetes Insipidus After Cranioplasty and Cranial Defect Repair
Sung, J. J., Mapstone, T. B., & Amm, C. A. E. (2011) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e31821da32f · Cited by 4
Complication Rates after Endoscopic Transsphenoidal Surgery for ACTH-Secreting Pituitary Adenomas: A Comparative Analysis with GH and Nonfunctioning Adenomas
Aibar‐Durán, J. Á., Oladotun-Anka, M., Cortés, C. A., Valassi, E., Webb, S. M., Gras-Cabrerizo, J. R., Montserrat-Gili, J. R., Tresserras, P., & Muñoz, F. (2021) · Journal of Neurological Surgery Part B Skull Base · doi:10.1055/s-0041-1725029 · Cited by 4
“Intraoperative CSF leak was also related to the presence of transient DI, in agreement with the results reported by Nemergut et al. 4 Finally, Mortini et al also reported that the prevalence of some endocrinological complications, such as hypopituita-rism and permanent diabetes insipidus, is inversely related to surgi…”
BackgroundResult
Late Recovery of Cranial Diabetes Insipidus following Pituitary Surgery
Glynn, N., O'Brien, D., & Agha, A. (2013) · Hormone Research in Paediatrics · doi:10.1159/000354656 · Cited by 4
Effects of nasal irrigation after endoscopic transsphenoidal resection in patients with pituitary adenomas
Xu, P., Liu, S., Dong, Y., Liang, W., Li, Z., & Liu, F. (2021) · Medicine · doi:10.1097/md.0000000000028317 · Cited by 3
“Generally speaking, neurosurgeons are trained to treat complex and serious diseases, such as cerebrospinal fluid rhinorrhea,([10]) diabetes insipidus,([11]) hypopituitarism, intracranial infection, and serious complications after transsphenoidal pituitary tumor resections and have less training in treating simple nasa…”
Background
Prediction of diabetes insipidus occurrence after endoscopic endonasal removal of sellar lesions using MRI-based radiomics and machine learning
Mastantuoni, C., Ugga, L., Solari, D., D’Aniello, S., Spadarella, G., Cuocolo, R., Angileri, F. F., & Cavallo, L. M. (2024) · Journal of Neurosurgical Sciences · doi:10.23736/s0390-5616.23.06162-3 · Cited by 3
Desmopressin dose requirements in patients with permanent arginine vasopressin deficiency: a tertiary center experience
Varaldo, E., Sibilla, M., Prencipe, N., Berton, A. M., Cuboni, D., Aversa, L. S., Mocellini, F., Bioletto, F., Ghigo, E., Gasco, V., et al. (2024) · Pituitary · doi:10.1007/s11102-024-01454-4 · Cited by 3
Anesthesia for Pituitary Surgery
Kim, J., & Scott-Miller, R. (2022) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2022.01.003 · Cited by 3
Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors
Hosri, J., Daou, C. A. Z., Darwish, H., & Korban, Z. R. (2024) · Journal of Neurological Surgery Reports · doi:10.1055/a-2324-1303 · Cited by 3
“9 In 2008, Sigounas et al studied 119 consecutive patients undergoing endoscopic pituitary surgery and noted that intraoperative CSF leak (36.8”
BackgroundInfluential
Nomogram for predicting diabetes insipidus following endoscopic transsphenoidal surgery in pituitary adenomas
Yu, X., Xu, G., & Qiu, P. (2024) · Journal of Neuroendocrinology · doi:10.1111/jne.13475 · Cited by 3
Pituitary Hormonal Changes after Transsphenoidal Tumor Removal in Non-Functioning Pituitary Adenoma
Lee, M.-S., Han, S. J., Kim, E., Hwang, J. A., Chung, Y., Kim, S. H., Cho, K. G., Rim, N.-J., & Kim, H. S. (2009) · Journal of Korean Endocrine Society · doi:10.3803/jkes.2009.24.3.181 · Cited by 3
Polyuria and Diabetes Insipidus
Bichet, D. G. (2012) · Elsevier eBooks · doi:10.1016/b978-0-12-381462-3.00046-x · Cited by 3
Hypernatremia and central Diabetes Insipidus following Neurosurgical procedure of Trauma
Magbri, A., El-Magbri, E., & Hershit, S. (2017) · Archives of Pathology and Clinical Research · doi:10.29328/journal.hjpcr.1001002 · Cited by 3
“Neurosurgical procedures and trauma to the hypothalamus and posterior pituitary may result in CDI in (10-20% to 60-80%) depending on the underlying type of the neurosurgical procedure [11-15].”
Background
Conventional and Endoscopic Approaches to the Pituitary
Kölln, K. A., & Senior, B. A. (2009) · Springer eBooks · doi:10.1007/978-3-540-74380-4_43 · Cited by 3
Endoscopic vs microscopic transsphenoidal surgery for Cushing's disease: a systematic review and meta-analysis
Broersen, L. H. A., Biermasz, N. R., van Furth, W. R., de, V. F., Verstegen, M. J. T., Dekkers, O. M., & Pereira, A. M. (2018) · Endocrine Abstracts · doi:10.1530/endoabs.56.gp202 · Cited by 3
Effects of psychological and physiological factors in perioperative thirst discomfort trajectories in endonasal transsphenoidal surgery: a prospective cohort study
Fu, Z., Luo, X., Liu, L., Shang, J., Chen, M., & Miao, X. (2025) · International Journal of Surgery · doi:10.1097/js9.0000000000002513 · Cited by 2
Diagnosis and treatment of hypernatremia
Tomkins, M., Donald, D. M., Green, D., O’Reilly, M., & Sherlock, M. (2025) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2025.102065 · Cited by 2
The surgical management of Cushing disease: a case series from a Canadian tertiary center.
Estephan, K., Charbonneau, L., Chennou, F., Jabre, R., Desrosiers, M., & Moumdjian, R. A. (2025) · Neurological Research · doi:10.1080/01616412.2025.2606225 · Cited by 2
Microsurgical Approaches for Transsphenoidal Surgery
Dunn, I. F., & Laws, E. R. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-0292-5.00011-5 · Cited by 2
Endoscopic Endonasal Resection of a Cavernous Malformation of the Third Ventricle: Case Report and Literature Review
Abdulqader, S. A. B., & AlZhrani, G. A. (2022) · Journal of Neurological Surgery Part A Central European Neurosurgery · doi:10.1055/s-0041-1741070 · Cited by 2
Assessment of multimodal treatment options in recurrent and persistent acromegaly: a systematic review and meta-analysis
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Smartphone Applications for Remote Monitoring of Patients After Transsphenoidal Pituitary Surgery: A Narrative Review of Emerging Technologies
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Development and validation of a predictive machine learning model for postoperative long-term diabetes insipidus following transsphenoidal surgery for sellar lesions
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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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