SFEBES2023 Poster Presentations Neuroendocrinology and Pituitary (74 abstracts)
A post-operative fluid restriction protocol to reduce the incidence of delayed hyponatraemia following trans-sphenoidal pituitary surgery
Hesarghatta Shyamasunder Asha , Aneez Joseph , Nitin Kapoor , Thomas Paul , Nihal Thomas , Felix Jebasingh , Kripa Elizabeth Cherian , Remya Rajan , Krishna Prabhu , Ari Chacko , Pamela Christudoss , Arun Jose & Grace Rebekah
Christian Medical College, Vellore, India
Delayed hyponatraemia(DH) is a well-known complication following trans-sphenoidal pituitary surgery (TSS), varying in incidence from 9–36% and occurs between post-operative days(POD) 4 to 14. Various studies have demonstrated that post-operative fluid restriction after TSS reduces the incidence of DH.
Objective: to assess whether a fluid restriction protocol from POD5 to POD14 following TSS reduces the incidence of post-operative DH in comparison to our historical cohort.
Methods: Prospective study, with fluid restriction to ≤1.5 liters/day from post-operative days 5 to 14 among patients who underwent TSS for pituitary tumours from 1 August 2021 to 30 April 2023. The proportion who developed DH was compared between the prospective cohort and our retrospective cohort of patients who underwent TSS and were managed by standard protocol [n=100, 1 November 2017 -31 December 2019].
Results: We recruited 80 subjects(45 males and 35 females) over 20 months in the prospective study, which included the summer of two years [temperature~106°F]. Seventy-three(91%) were macroadenomas and 60% were invasive, including 35 functioning tumours(44%) -26 acromegaly and 9 Cushing’s disease. The pre-operative pituitary hormonal deficiencies included secondary hypogonadism-69%, secondary hypothyroidism-51% and secondary hypocortisolism-35%. Twelve subjects(15%) developed transient post-operative diabetes-insipidus. Eleven subjects(13.7%) developed delayed hyponatraemia(DH) between POD4 -14. Nine subjects were non-compliant with fluid restriction, but none required hospital readmission. Sixty-six subjects(82.5%) were compliant with fluid restriction, among them only 2(3%) developed DH vs. 9(64%) non-compliant subjects(P<0.005). The proportion with post-operative DH reduced significantly from 36% with standard post-operative management in our retrospective cohort to 13.7% with a post-operative fluid restriction protocol.
Conclusions: Post-operative fluid restriction is a simple and cost-effective method to avoid delayed hyponatraemia in patients undergoing TSS for pituitary tumours. Moderate fluid restriction is possible even in tropical countries like India.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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