Central diabetes insipidus after transsphenoidal treatment for tumors of the sellar region: prognostic factors for transient course of the disease
Ekaterina Pigarova, Liudmila Rozhinskaya, Andrey Grigoriev & Larisa Dzeranova
Central diabetes insipidus (CDI) is a common complication after transsphenoidal treatment for tumors of the sellar region and may exhibit different patterns: transient, permanent or triphasic.
The aim of our study was to determine the incidence and course of the CDI and to characterize the factors associated with resolution of this disease.
The incidence of CDI was based on records of 318 patients who underwent transsphenoidal surgery at our institution between 2004 and 2008 by a single surgeon. The main study included 48 patients (32 with transient and 16 with permanent) with postoperative CDI, operated in part in other neurosurgical institutions, and were available for follow-up.
CDI was diagnosed in 12.9% of our patients (41/319). There were no differences between groups of transient and permanent CDI in patients age (36.2 vs 32.1 years), body mass index (27.4 vs 26.7 kg/m2), duration of preoperational anamnesis of main disease (5.6 vs 6.2 years), tumor volume (1.7 vs 3.1 cm3; P=0.29), cavernous sinus involvement (P=0.44) or pituitary stalk deviation (P=0.48). Median time to resolution of CDI was 9 weeks ranging from 2 days to 1.5 years. We were not able to show that narcosis duration, amount of haemorrhage, liquorrhea, traumatization of neurohypophysis, intraoperational use of H2O2 or formic acid as well as number of mitoses, stromal edema or degenerative changes at histological appearance of removed tumor could influence the resolution of postoperative CDI (for all P>0.05). Transient CDI was associated with previous therapeutic treatment of the tumor (P=0.04), hormone hypersecretion (P=0.007) and tumor size less than 1 cm in diameter (P=0.02).
Thus, herein we report an incidence of CDI within our postoperative population and describe factors that favor transient course of the disease.