Endocrine Abstracts

Purpose

Postoperative central diabetes insipidus (PCDI) is one of the complications of transsfenoidal adenomectomy (TSA) in patients with Cushing’s disease. Identification of predictors of PCDI development and clinical course could optimize the management of such patients.

Aim

To study the prevalence of PCDI in patients with Cushing’s disease after transsphenoidal adenomectomy and to find the risk factors of its development.

Methods

Medical histories of 116 patients with Cushing’s disease were retrospectively analyzed. All patients underwent TSA in Almazov Centre during the period from January 2016 to December 2018. 111 patients were operated on initially, and five were re-operated. Clinical, preoperative MRI images and histology data were studied.

Results

Among 116 patients PCDI developed in 25 (22%) cases (23 women (92%)). Eighteen patients (72%) had transient form of the disease, and seven (28%)-permanent. In two cases (8%) triphasic DI was confirmed. Adenoma size and localization did not differ in patients with and without PCDI. In 9 patients without PCDI and 8 patients with PCDI the presence of neurohypophysis tissue was confirmed by histological examination of the removed sample. Among 111 initially operated patients PCDI developed in 23 (20, 7%), among five re-operated patients – in two (40%). Need for desmopressin therapy for 6 months or more indicated the permanent form of the disease. The average dose of desmopressin in patients with transient form of the disease was 120 mcg (min 30 mcg; max 240mcg). The average dose of desmopressin in patients with permanent PCDI was 210 mcg (min 60 mcg; max 360mcg).

Conclusion

The prevalence of central diabetes insipidus after TSA among patients with CD is high and amounts to 22%. In most cases the form of the disease is transient. Repeated surgery is the risk factor of PCDI development. The need for high doses of desmopressin increases the likelihood that diabetes insipidus will be permanent. The need for desmopressin therapy for 6 months or more indicates a permanent form of the disease.