Purpose: Although transient diabetes insipidus (DI) is the most common complication of pituitary surgery, there is no consensus on its definition. Polyuria is the most overt symptoms of DI, but can also reflect several physiological adaptive mechanisms in the postoperative phase However, establishing uniform definitions is challenging, especially for early postoperative complications such as diabetes insipidus (DI) and postoperative hyponatremia. Postoperative DI is caused by vasopressin deficiency and is one of the most reported complications after pituitary tumor surgery [ 33 ]
Factors Associated with Postoperative Diabetes Insipidus after Pituitary Surgery Antonio L. Faltado Jr., Anna Angelica Macalalad-Josue, Ralph Jason S. Li, John Paul M. Quisumbing, Marc Gregory Y. Yu, Cecilia A. Jimeno Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of th J. Seckl, D. Dunger. Seckl J., Dunger D.. Postoperative diabetes insipidus. British Medical Journal 1989; 298 :2. BibTeX (win & mac) Download. EndNote (tagged) Download. EndNote 8 (xml) Download. RefWorks Tagged (win & mac) Download. RIS (win only) Download Approach to Post -operative Diabetes Insipidus . 1. Routine Post-operative Monitoring for DI: • Record intake and fluid output on an hourly basis • Measure SNa every 12 hours (Urine Spec Gravity every 12 hours, alternating) 2. Expectant Management when DI occurs: • Allow free access to water: increased plasma osmolality stimulates thirs Not all cases of diabetes insipidus are permanent. The most common causes of postoperative polyuria are excretion of excess fluid given during surgery and an osmotic diuresis as a result of treatment for cerebral edema. D. Manifestation: one of 3 patterns can be exhibited. 1. Transient. 2. Permanent. 3. Triphasic: more often clinically observe
During the postoperative period, Diabetes insipidus (DI) is most commonly associated with: Subarachnoid hemorrhage (especially associated with an anterior communicating artery aneurysm) Most patients with DI do NOT require specific treatment if they have ready access to fluids. Indeed, most DI after pituitary surgery is transient and no permanent Diabetes insipidus (DI) after endoscopic transsphenoidal surgery (ETSS) can lead to increased morbidity, longer hospital stays, and increased medication requirements. Predicting which patients are at high risk for developing DI can help direct services to ensure adequate care and follow-up Postoperative Copeptin Concentration Predicts Diabetes Insipidus After Pituitary Surgery In patients undergoing pituitary procedures, low copeptin levels despite surgical stress reflect postoperative DI, whereas high levels virtually exclude it. Copeptin therefore may become a novel tool for early goal-directed management of postoperative DI
We report the results of a prospective randomized controlled trial, which looked at the incidence of postoperative diabetes insipidus (DI) following the use of three different hydrocortisone protocols, and the results of a study, on the incidence of DI and cortisol response in patients not given hydrocortisone. In study 1, 114 patients with. The objective is to determine whether copeptin is a predictive marker of postoperative diabetes insipidus (DI). Methods. This is a prospective diagnostic study. Patients who underwent neurosurgical intervention of the sellar-suprasellar regions were recruited. Serum copeptin levels were measured before and after surgery, within 24 hours
The third phase can be permanent diabetes insipidus, when stores of ADH are exhausted and the cells that produce more ADH are absent or unable to produce. Polyuria, polydipsia, and nocturia (from 3-18 L) are the predominant symptoms. Factors found to increase the risk of postoperative diabetes insipidus include young age, male sex You are going to email the following Postoperative diabetes insipidus. Your Personal Message . CAPTCHA . This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. UK jobs; International jobs Postoperative diabetes insipidus began on day 2 and lasted until day 6, when decreased urine output and a fall in serum sodium level signaled the start of the second phase of inappropriate. Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Albinusdreef 2, Leiden, Postbox 9600, 2300 RC, The Netherlands. Author profile. Search articles by ORCID. 0000-0002-1194-9866 Diabetes insipidus (DI) is a common complication following transsphenoidal surgery for sellar and suprasellar masses. Untreated DI can cause a patient to develop hypernatremia and serum hyperosmolality, potentially leading to dehydration, lethargy, irritability, and, in the case of severe hypernatremia, seizures [].The primary clinical symptoms of DI are polyuria and polydipsia, especially for.
Postoperative Diabetes Insipidus and Hyponatremia in Children after Transsphenoidal Surgery for Adrenocorticotropin Hormone and Growth Hormone Secreting Adenomas. Saldarriaga C, Lyssikatos C, Belyavskaya E, Keil M, Chittiboina P, Sinaii N, Stratakis CA, Lodish M. J Pediatr, 195:169-174.e1, 01 Feb 201 Preoperative diagnosis of diabetes insipidus (DI) is rare in the setting of a pituitary adenoma and should prompt consideration of alternative diagnoses, such as craniopharyngioma or Rathke cleft cyst (RCC) [].Postoperative DI, however, is not a rare finding after sellar mass resections, with reported incidences typically ranging from 9% to 22% but up to 54% at some institutions [] Postoperative Diabetes Insipidus and Hyponatremia in Children after Transsphenoidal Surgery for Adrenocorticotropin Hormone and Growth Hormone Secreting Adenomas. Carolina Saldarriaga Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD
To identify risk factors for the development of postoperative diabetes insipidus (DI) in a modern cohort of endoscopic endonasal transsphenoidal surgery. Analysis of prospectively collected data of 449 consecutive patients operated on for anterior skull base pathology. DI was defined as a polyuria (> 250 ml/h for ≥ 2 consecutive hours) polydipsia syndrome associated with hypotonic urine with. This is a CME-CPD accredited activity. Number of credits: 1. Description. This session will help you recognize the different etiologies of the polyuria polydipsia syndrome, identify the limitations of the water deprivation test, interpret copeptin upon hypertonic saline infusion, understand non-osmotic stimuli of copeptin and their possible value in the differential diagnosis of Diabetes. Approach to Post -operative Diabetes Insipidus . 1. Routine Post-operative Monitoring for DI: • Record intake and fluid output on an hourly basis • Measure SNa every 12 hours (Urine Spec Gravity every 12 hours, alternating) 2. Expectant Management when DI occurs: • Allow free access to water: increased plasma osmolality stimulates thirs Diabetes insipidus (DI) is an uncommon perioperative complication that can occur secondary to medications or surgical manipulation and can cause significant hypovolemia and electrolyte abnormalities. We reviewed and evaluated the current literature and identified 24 cases of DI related to medications commonly used in anesthesia such as propofol. Pre-operative central diabetes insipidus has been reported in 8-35% of patients affected with craniopharyngioma, and in 70-90% after surgery. The management of postoperative polyuria and polydipsia can be challenging and fluid balance needs to be closely monitored
RESULTS: Group A patients did not have postoperative permanent diabetes insipidus (DI). Preoperative images in 17 patients revealed linear or ovoid HSI on the adenoma surface immediately above the diaphragma sellae. Of these, two with a poorly developed diaphragma sellae had HSI near the median eminence and inside the sella turcica Children with a suprasellar tumours are at risk of developing panhypopituitarism, along with diabetes insipidus. This guideline has been written to aid in the diagnosis, post-operative management, monitoring and potential complications of diabetes insipidus A retrospective study by Andereggen et al found that in patients who underwent craniopharyngioma surgery, the presence of postoperative diabetes insipidus was an independent risk factor for hypothalamic obesity (odds ratio 15.2)
Hadjizacharia P, Beale EO, Inaba K, et al. Acute diabetes insipidus in severe head injury: a prospective study. J Am Coll Surg 2008; 207:477. Seckl JR, Dunger DB, Bevan JS, et al. Vasopressin antagonist in early postoperative diabetes insipidus. Lancet 1990; 335:1353 Pre-operative central diabetes insipidus has been reported in 8-35% of patients affected with craniopharyngioma, and in 70-90% after surgery. The management of postoperative polyuria and polydipsia can be challenging and fluid balance needs to be closely monitored. The classical triphasic pattern of.
The Lancet MEDICAL SCIENCE Vasopressin antagonist in early postoperative diabetes insipidus J.R. Seckl PhD * a * Correspondence to Dr J. R. Seckl, Department of Medicine, Western General Hospital, Edinburgh EH4 2XU, UK C. Chowdrey PhD a Prof S.L. Lightman FRCP a D.B. Dunger MD b J.S. Bevan MD c Y. Nakasu MD c C.W. Burke FRCP c a Medical Unit, Charing Cross and Westminster Medical School. To identify risk factors for the development of postoperative diabetes insipidus (DI) in a modern cohort of endoscopic endonasal transsphenoidal surgery. Methods Analysis of prospectively collected data of 449 consecutive patients operated on for anterior skull base pathology. DI was defined as a polyuria (> 250 ml/h for ≥ 2 consecutive hours. Central diabetes insipidus (DI) is a significant postoperative complication of pituitary tumor resection. Disturbance of the posterior pituitary, pituitary stalk, or neurons originating in the paraventricular or supraoptic hypothalamic nuclei during pituitary tumor resection may lead to transient or permanent imbalance of antidiuretic hormone-regulated water homeostasis () Seckl J, Dunger D. Postoperative diabetes insipidus. BMJ. 1989 Jan 7. 298(6665):2-3. . . Hannon MJ, Sherlock M, Thompson CJ. Pituitary dysfunction following traumatic brain injury or subarachnoid haemorrhage - in Endocrine Management in the Intensive Care Unit. Best Pract Res Clin Endocrinol Metab. 2011 Oct. 25(5):783-98 Central diabetes insipidus (DI) is observed in 16-34% of patients recovering from sellar region operations (2- 4). Although generally transient (4, 5), this condition may prolong hospitalization and cause morbidity after pituitary procedures (6, 7), and may lead to severe hypernatremia if fluid is not immediately replenished
Postoperative Diabetes Insipidus and Hyponatremia in Children after Transsphenoidal Surgery for Adrenocorticotropin Hormone and Growth Hormone Secreting Adenomas. J Pediatr. 2018; 195:169-174.e1 (ISSN: 1097-6833 Postoperative Copeptin Concentration Predicts Diabetes Insipidus After Pituitary Surgery. We hypothesized that following stress from pituitary surgery, patients with neurohypophyseal damage and eventual diabetes insipidus (DI) would not exhibit the expected pronounced copeptin elevation Thank you for your interest in spreading the word about The BMJ. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail The presence of diabetes insipidus in the postoperative period was established by measuring serum Na+ concentration, hourly urine output and urinary specific gravity to find out the incidence of diabetes insipidus in postoperative period in relation to age, gender, tumour diameter, function of tumour (i.e., either hormone secreting or not) and.
Conclusions: ACTH- and GH-secreting adenomas, macroadeomas and postoperative adrenal insufficiency can be considered as predictors of transient and three-phased diabetes insipidus. Panhypopituitarism can be considered as predictor of permanent diabetes insipidus Nevertheless, it is of great importance because diabetes insipidus (DI), a pathologic condition associated with polyuria, polydipsia, and low urinary osmolality resulting from low ADH release from the pituitary posterior lobe into the blood, is one of the most common postoperative complications of transsphenoidal surgery; it is reported to. In patients undergoing pituitary surgery, copeptin levels represent a novel marker for postoperative diabetes insipidus, according to data published in the Journal of Clinical Endocrinology & Metabolism. Central diabetes insipidus is observed in 16% to 34% of patients recovering from sellar region operations
The median postoperative LOS decreased from 8 days in control group to 3 days in ERAS group (P<.05). ERAS group had better economic benefit with less Hospital charges (P<.05). There was no difference in the early postoperative diabetes insipidus and 30-day readmission for epistaxis, hyponatremia, or other complications between the two groups Nayak P, Montaser AS, Hu J, Prevedello DM, Kirschner LS, Ghalib L: Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas. J Endocr Soc 2: 1010 - 1019, 201 Significance of postoperative fluid diuresis in patients undergoing transsphenoidal surgery for growth hormone-secreting adenomas. Diabetes insipidus in craniopharyngioma: postoperative management of water and electrolyte disorders. J Pediatr Endocrinol Metab 2006;. Frequent postoperative complications of giant tumor incision in sellar region through anterior interhemispheric approach include diabetes insipidus and imbalance of water and electrolyte. In the group of cases, 81 cases (70.4%) had diabetes insipidus and 68 cases (56.4%) underwent imbalance of water and electrolyte after surgery in the hospital Postoperative Management. Patients are monitored in an intensive care unit in the immediate postoperative period with monitoring for neurological deterioration, epistaxis, visual dysfunction, diabetes insipidus (DI), and hypotension secondary to acute hypocortisolism
Background: Postoperative diabetes insipidus (DI) is a significant cause of morbidity in craniopharyngiomas (CP) and its effective management improves outcome. Objective: The objective was to determine the efficacy of a treatment protocol in the management of early postoperative DI in CP The reported incidence of postoperative diabetes insipidus (DI) is highly variable. In this study, we report our experience with DI following endoscopic transsphenoidal surgery (TSS) for PAs, elucidating the risk factors of postoperative DI, the likelihood of long-term DI, and the impact of DI on the length of stay (LOS) All had corticosteroid and thyroxine replacement; 9 developed diabetes insipidus (DI) within 1-12 h of operation. At the onset of DI, the plasma vasopressin (AVP) concentration was 3.9 ±1.2 pmol/1, considerably higher values usually associated with cranial DI (< 0.9 pmol/1) Cephalocaudal tumor diameter is a predictor of diabetes insipidus after endoscopic transsphenoidal surgery for non-functioning pituitary adenoma. Hyongmin Oh, Hyeon Cheun, Yoon Jung Kim, Hyun Kyu Yoon, perioperative laboratory findings, postoperative complications, readmission and hospital length of stay were collected and analyzed.. Incidence of adjuvant radiation and new postoperative diabetes insipidus in NCAs versus SGAs. Patients with NCAs are more likely to develop new postoperative diabetes insipidus than patients with SGAs (4.7% vs 12.1%, *p = 0.028). Patients with NCAs are also more likely to require adjuvant radiation therapy (23.4% vs 9.4%, **p = 0.002)
