Endocrine Abstracts

Objectives: To evaluate predictors of permanent, transient and three-phase diabetes insipidus (DI) in patients undergoing endoscopic endonasal transsphenoidal surgery.

Patients and methods: The study included 154 patients undergoing endoscopic endonasal transsphenoidal surgery (122 women and 32 men) age from 18 to 65 years (median 40 (31;52)). 73 patients with Cushing disease, 66 patients with acromegaly, four patients with prolactinomas, nine patients with non-functioning pituitary adenomas, one patient with thyrotropinoma, one patient with Nelson’s syndrome and three patients with multihormonal secreting adenomas we examined. Patients were monitored for hormones, balance of fluids, serum electrolytes, plasma and urine osmolality.

Results: Postoperative permanent DI occurred in 27 patients, among them four as three-phased disturbances. Transient DI occurred in 42 patients, among them nine as three-phased disturbances. Onset arised on the 1th day–2nd month after surgery (median 1 day (1;5)) for the permanent DI’s and on the 1th day–4th month for transient DI’s (median 1 day (1;5)). Duration for transient DI was 1 day–1 year and 3 month (median 2 (1;30)), in 38% patients transient DI occurred as single polyuria-polydipsia episode. Adrenal insufficiency incrised risk of transient and three-phased DI development (RR 0.516 (0.287; 0.927), P=0.02, RR 0.056 (0.008; 0.42), P=0.0003, respectively), panhypopituitarism increased permanent DI onset risk (RR 0.264 (0.132; 0.53), P=0.02). Patients with corticotropinomas and somatotropinomas had higher risk of transient and three-phased DI (RR 0.212 (0.061; 0.734), P=0.02, RR 0.459 (0.311; 0.677), P=0.04, for corticotropinomas, respectively; RR 4.559 (1.049; 19.813), P=0.03, RR 1.977 (1.033; 3.783), P=0.07 for somatotropinomas, respectively). Macroadenoma also increased risk of transient and three-phased DI (RR 5.739 (1.32; 24.962), P=0.01, RR 2.593 (1.357; 4.955), P=0.02, respectively).

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.