The Analysis Of Releated Factors For Hyponatremia After Transsphenoidal Pituitary Adenoma Ectomy

Pituitary adenoma is a kind of benign tumor of nervous system, account for about 10% of intracranial tumors. Surgery , drug therapy and radiotherapy are the main treatment methods. Most people suffered from pituitary adenoma choose Transsphenoidal surgery as the first-selected treatment modality. And the hyponatremia is one of the common complications after Transsphenoidal approach. Medical circle of various countries began to pay more attention to the hyponatremia after Transsphenoidal surgery (TSS) since 1990s, but based on their own clinical and basic research there is still some words on debate in this field.In our study, a series of 56 people with pituitary adenoma via Transsphenoidal microsurgery from January 2007 to December 2008 in China-Japan Union Hospital attached to Jilin University was analyzed retrospectively, to discuss the related factors of hyponatremia after TSS. Methods: All the fifty-six patients in the series suffered a Transsphenoidal microsurgery by the same neurosurgeon, and make sure that each of them have a complete data. The clinical presentation, pituitary hormones examination, plasma ion levels before and after operation, urine volume of each and every twenty-four hours after operation, pathological types of the adenoma , conditions of the adenomas were retrospective analyzed. Discuss the relationship between the mortality of hyponatremia after Transsphenoidal surgery and the factors above. The results was analyzed by SPSS (version 13.0). A Fisher exact test was used, and the 2-sided probability value of <0.05 was considered to be statistically significant.Results: 14 patients (25%) developed postoperative hyponatremia, most of them happen in the forth to the tenth day after operation. The minimum plasma sodium level is 116mmol/L. The symptoms were usually mild (headaches, light headedness, nausea, vomiting). None of the 14 patients operated on a pituitary adenoma by the Transsphenoidal approach developed seizures and conscious disturbance during hyponatremia. Water restriction and salt rich diet was given to all the fourteen patients. 5 patients received hypertonic saline (3%) infusion, and oral sodium supplementation was given to others. None of them developed the demyelination syndrome.1.Occurrence of hyponatremia after Transsphenoidal pituitary surgery in relation to the age of the patients. The morbility of hyponatremia of twenty to forty years old group is 23.5%, and the forty to sixty years old group is 23.3%, respectively (p>0.05) .2.Occurrence of hyponatremia after Transsphenoidal pituitary surgery in relation to the sex of the patients. The morbility of hyponatremia after Transsphenoidal pituitary surgery of female is 31.3%, and 16.7% of the males. The Fisher exact 2-sided significance is 0.350.3.Occurrence of hyponatremia after Transsphenoidal pituitary surgery in relation to the age of the biological nature of the adenomas.66.7% of the non-function pituitary adenoma patients developed hyponatremia after Transsphenoidal surgery, and the mobility in the patients with PRL secreting adenomas is 20.0% (P=0.022), and 6.7% (P=0.003) of the patients who suffered mixed type adenomas. The difference of morbility in these three types of adenomas is statistically significant.56.3% patients with giant pituitary adenomas developed hyponatremia after transsphenoidal surgery, and the morbility in patients who suffered macroadenomas was 14.3. Fisher exact test shows the 2-sided significance is 0.005.There were 9 patients were confirmed suffered adenoma apoplexy, and 33.3% of them developed hyponatremia after Transsphenoidal surgery, 23.4% of the other 47 patients developed hyponatremia. Fisher exact test shows the 2-sided significance is 0.067.4.Occurrence of hyponatremia after Transsphenoidal pituitary microsurgery in relation to postoperative diabetes insipidus (DI).There were 37 (66.07%) patients complicated diabetes insipidus, and 12 of 14 patients who suffered hyponatremia combine with diabetes insipidus. The difference of morbility of post operative hyponatremia between DI group and normal urine volume group has no statistically significance (P=0.106).5.Compare of the hospitalization time.The patients developed hyponatremia after Transsphenoidal microsurgery have longer postoperative hospitalization days (11.7±3.7days) than the normal sodium group (8.9±3.3days). student test shows the probality value is 0.018, the difference has statistically significanceConclusion: Hyponatremia is a common complication after Transsphenoidal pituitary microsurgery. Size and type of adenomas have relationships with the incidence of hyponatremia after transsphenoidal pituitary adenoma ectomy. The sex and age of patients, the texture of adenoma, adenoma apoplexy, and postoperative diabetes insipidus have not obviously correlation relationships with hyponatremia after Transsphenoidal pituitary microsurgery. Patients with non-functional adenoma have a higher morbility of postoperative hyponatremia than whom with PRL secreting adenoma and mixed type adenoma. People who suffered pituitary giant adenoma have a higher morbility of postoperative hyponatremia than patients with macroadenoma. The hyponatremia make the postoperative hospitalization time longer.