Endocrine Abstracts

Introduction: Transsphenoidal surgery is the gold standard of treatment for most masses of the hypothalamic-pituitary region. Given the frequency of its performance in large hospitals, water-electrolyte complications are quite common and are the second most common cause of re-hospitalization of patients. Water-electrolyte disorders after transnasal adenomectomy in up to 30% of cases are associated with the development of severe neurological symptoms, decrease in the quality of life of patients, and increase in the duration of their stay in hospital, thus, the search for ways of early prediction is an extremely urgent task.

Objective: To analyze preoperative patient parameters to develop a prognostic model for the development of hyponatremia in patients after transnasal adenomectomy.

Materials and methods: A total of 117 patients were included in the analysis, 36 of which (31%) were men. Patients were divided into two groups: with developed hyponatremia by the 7th day after surgery and with its absence. Both groups were comparable in sex (P=0.26) and age (50.5 years [33.5; 61.5] vs 46 years [36; 57], P=0.43). These groups were compared according to 21 characteristics, including hormonal background parameters (ACTH, cortisol, TSH, FT4), presence of cardiovascular diseases, disorders of carbohydrate metabolismand hypogonadism, current drug therapy, as well as tumor characteristics according to MRI and characteristics of the surgical intervention protocol.

Results: According to the analysis performed, no significant differences were found in both groups for any of the input features (P>0.05). The same groups were then compared in terms of laboratory parameters depending on the reference interval of the laboratories (TSH/ACTH/cortisol/FT4 above/below/or equal to the reference interval), tumor characteristics (color, consistency, position relative to the pituitary gland, tumor bleeding, etc.) and tumor morphology. No differences were found for any of the characteristics for which the groups were compared (all P>0.05). Thus, the groups with hyponatremia on the 7th day after surgery and without hyponatremia on the 7th day after surgery did not differ statistically significantly, which did not allow to build a prognostic mathematical model of this complication.

Conclusions: The inability to predict the development of postoperative hyponatremia on the basis of preoperative parameters, peculiarities of surgical intervention, dictates the necessity of blood sodium monitoring up to 10-14 days after transnasal adenomectomy.