Delayed postoperative hyponatremia after endoscopic transsphenoidal surgery for pituitary adenoma

  • Yusuke Tomita
  • Kazuhiko KurozumiEmail author
  • Kenichi Inagaki
  • Masahiro Kameda
  • Joji Ishida
  • Takao Yasuhara
  • Tomotsugu Ichikawa
  • Tomoko Sonoda
  • Fumio Otsuka
  • Isao Date
Original Article - Tumor - Other
Part of the following topical collections:
  1. Tumor – Other



Hyponatremia generally occurs after transsphenoidal surgery (TSS) in a delayed fashion. Most patients with delayed postoperative hyponatremia (DPH) are asymptomatic or only express non-specific symptoms; consequently, DPH is associated with prolonged hospitalization. No consensus has been reached on which patients are at greatest risk of developing DPH. We reviewed patients with DPH and evaluated predictive factors for DPH.


We retrospectively analyzed 107 consecutive patients who underwent endoscopic TSS for pituitary adenoma (January 2010–December 2016). Patients with DPH (hyponatremia group) and without DPH (normonatremia group) were compared according to their nadir sodium levels on postoperative days 3 to 10. We documented the patients’ demographics, clinical features, and postoperative physiological characteristics.


Twenty-five (23.4%) patients developed DPH after endoscopic TSS. The patients’ mean age was 54 ± 17 years, and 63.6% of the patients were female. The overall prevalence of DPH was 23.4%. The non-parametric χ2 test and the Mann–Whitney U test revealed statistically significant differences in age, use of antihypertensive drugs, nonfunctioning pituitary adenoma, and higher yet normal preoperative thyroid-stimulating hormone level between the hyponatremia and normonatremia groups (P < 0.05). Logistic regression analysis revealed that only older age was a useful independent predictive factor for DPH (odds ratio, 1.05; 95% confidence interval, 1.01–1.08; P = 0.01). The serum sodium levels on postoperative day 2 were significantly lower in the hyponatremia than normonatremia group (P < 0.01) and were negatively correlated with age (r = − 0.25, P < 0.05). The cut-off age for predicting DPH was 55 years. The hospital stay was significantly longer in the hyponatremia than normonatremia group (P < 0.01).


Age of more than 55 years was an independent predictive factor for DPH even after adjusting for potential confounders. Older age was negatively correlated with the serum sodium level on postoperative day 2. Preventing early decreases in the sodium level could reduce the risk of DPH.

Trial registration



Endoscopic transsphenoidal surgery Hyponatremia Pituitary adenoma 



We thank Angela Morben, DVM, ELS, from Edanz Group (, for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Yusuke Tomita
    • 1
  • Kazuhiko Kurozumi
    • 1
    Email author
  • Kenichi Inagaki
    • 2
  • Masahiro Kameda
    • 1
  • Joji Ishida
    • 1
  • Takao Yasuhara
    • 1
  • Tomotsugu Ichikawa
    • 1
  • Tomoko Sonoda
    • 3
  • Fumio Otsuka
    • 4
  • Isao Date
    • 1
  1. 1.Department of Neurological SurgeryOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
  2. 2.Endocrine CenterOkayama University HospitalOkayamaJapan
  3. 3.Department of Public Health, School of MedicineSapporo Medical UniversitySapporoJapan
  4. 4.Department of General MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan

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