Water and sodium disorders following surgical excision of pituitary region tumours
Tóm tắt
A prospective observational study of the pathophysiology of sodium and water disorders in patients with pituitary region tumours after surgical excision was carried out in 20 patients. Serial pre-operative and post-operative fluid and sodium balance, plasma and urine elctrolyte biochemistry and their derived parameters, and circulating hormones associated with fluid balance, atrial natriureic peptide (ANP) and antidiuretic hormone (ADH) were documented to correlate with the patients' clinical conditions. Ten out of these twenty cases developed diabetes insipidus (DI) requiring ADH replacement therapy, although in the majority (6 cases), this way only a transient event. Of the nine patients who developed hyponatraemia, six had symptoms such as impaired consciousness and convulsions. Four patients developed alternating hypoatraemia and hypernatraemia, which constituted a difficult group, where appropriate sodium and fluid management, and ADH replacement therapy were based upon twice daily plasma and urine biochemistry and their derived parameters. Whilst DI in this group of patients was the result of a low circulating ADH level, hyponatraemia was not associated with an exaggerated ADH activity (6.0 ± 2.3 vs 7.4 ± 2.3 pmol/ml, mean ± SEM). Rather, hyponatraemia was strongly associated with an elevated circulating ANP concentration (82.4±10.5 vs 30.0 ±3.1 pmol/ml, mean ± SEM, p < 0.001), resulting in salt wasting and hypovolaemia.
Tài liệu tham khảo
Cogan E, Debieve MF, Pepersack T, Abramow M (1988) Natriuresis and atrial natriuretic factor secretion during inappropriate antidiuresis. Am J Med 84: 409–418
Cusick JF, Hagen TC, Findling JW (1984) Inappropriate secretion of antidiuretic hormone after transspenoidal surgery for pituitary tumors. N Engl J Med 311: 36–38
Doczi T, Bende J, Huska E, Kiss J (1981) Syndrome of inappropriate secretion of antidiuretic hormone after subarachnoid haemorrhage. Neurosurgery 4: 394–396
Fox JL, Falik JL, Shalhoub RJ (1971) Neurosurgical hyponatraemia: the role of inappropriate antidiuresis. J Neurosurg 34: 506–514
Hans P, Stevenaert A, Albert A (1986) Study of hypotonic polyuria after transsphenoidal pituitary adenomectomy. Intensive Care Med 12: 95–99
Hildebrandt G, Mueller HW (1991) Disturbances of waterelectrolyte regulation after surgery of the hypothalamus and pituitary region. In: Bock WF, Lumenta Ch, Brock M, Klinger M (eds) Advances in neurosurgery, Vol 19. Springer, Berlin Heidelberg New York Tokyo, pp 234–239
Inagami T, Tanaka I, McKenzie JC, Nakamaru Met al (1989) Discovery of atrial natriuretic factor in the brain: its characterisation and cardiovascular implication. Cell Mol Neurobiol 9: 75–85
Joynt RT, Afifi A, Harbison J (1965) Hyponatraemia in subarachnoid haemorrhage. Arch Neurol 13: 633–638
Kazda A, Jabor A, Zamecnik M, Masek K (1989) Monitoring acid-base electrolyte disturbances in intensive care. Adv Clin Chem 27: 201–264
Lipsett MB, Maclean JP, Weat CD, Li MC, Pearson OH (1956) An analysis of the polyuria induced by hypophysectomy in man. J Clin Endocrinol Metab 16: 183–195
Lolin Y, Jackowski A (1992) Hyponatremia in neurosurgical patients: diagnosis using derived parameters of sodium and water homeostasis. Br J Neurosurgery 6: 457–466
Lyen KR, Grant DB (1982) Endocrine function, morbidity and mortality after surgery for craniopharyngioma. Arch Dis Child 57: 837–841
Morton JJ, Connell JMC, Hughes MJet al (1985) The role of plasma osmolality, angiotensin II and dopamine in vasopressin release in man. Clin Endocrinol 23: 508–519
Nelson PB, Seif SM, Maroon JC, Robertson AG (1981) Hyponatraemia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Neurosurg 55: 938–941
Newman CB, Levine LS, New MI (1981) Endocrine function in children with intrasellar and suprasellar neoplasms: before and after therapy. Am J Dis Child 135: 259–262
Ng HK, Poon WS (1995) Sinus histiocytosis with massive lymphadenopathy localised to the sella. Br J Neurosurg 9: 551–555
Peters JP, Welt KG, Sims EAH, Orloff J, Needham J (1950) A salt-wasting syndrome associated with cerebral disease. Trans Ass Am Physiol 63: 57–64
Poon WS, Mendelow AD, Davies DL, Watson W, Easton J, Morton J (1989) Secretion of antidiuretic hormone in neurosurgical patients: appropriate or inappropriate? Aust NZ J Surg 59: 173–180
Sane T, Rantakari K, Poranen A, Tahtela R, Valimaki M, Pelkonen R (1994) Hyponatremia after transsphenoidal surgery for pituitary tumors. J Clin Endocrinol Metab 79: 1395–1398
Schwartz WB, Bennett W, Curelop S (1957) A syndrome of renal sodium loss and hyponatraemia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23: 529–542
Seckl JR, Dunger DB, Lightman SE (1987) Neurohypophyseal function during early postoperative diabetes insipidus. Brain 110: 737–746
Shimoda M, Yamada Sh, Yamamoto I, Tsugane R, Sato O (1989) Atrial natriuretic polypeptide in patients with subarachnoid haemorrhage due to aneurysmal rupture. Acta Neurochir (Wien) 97: 53–61
Thomsett MJ, Conte FA, Kaplan SE, Grumbach MM (1980) Endocrine and neurological outcome in childhood craniopharyngioma: review of effect of treatment in 42 patients. J Pediatr 97: 728–735
Ultmann MC, Hoffman GE, Nelson PB, Robinson AG (1992) Transient hyponatremia after damage to the neurohypophyseal tracts. Neuroendocrinology 56: 803–811
Wijdicks EFM, Vermeulen M, Van Gijn J (1990) Hyponatraemia and volume status in aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 47: 111–113
Wise BL (1978) Syndrome of inappropriate antidiuretic hormone secretion after spontaneous subarachnoid haemorrhage: a reversible cause of clinical deterioration. Neurosurgery 3: 412–414
Yamaki T, Tano-oka A, Takahashi A, Imaizumi T, Suetake K, Hashi K (1992) Cerebral salt wasting syndrome distinct from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Acta Neurochir (Wien) 115: 156–162
Yamanoto N, Miyamoto N, Seo H, Matai N, Kuwayama A, Terashima K (1987) Hyponatremia with high plasma ANP level. Report of two cases with emphasis on the pathophysiology of cerebral salt wasting. Neurol Surg 15: 1019–1023 (English Abstract)
Yandle TG, Espiner EA, Nicholls MG, Duff H (1986) Radioimmunoassay and characterisation of atrial natriuretic peptide in human plasma. J Clin Endocrinol Metab 63: 72–75