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Delayed postoperative hyponatremia in patients with acromegaly: incidence and predictive factors

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Abstract

Purpose

Delayed postoperative hyponatremia (DPH) is a unique complication of transsphenoidal surgery (TSS) in pituitary tumors. Growth hormone (GH) enhances renal sodium reabsorption; however, the association between postoperative GH reduction and DPH in acromegaly is unclear. This study was performed to clarify the incidence of and the predictive factors for DPH in patients with acromegaly who underwent TSS.

Methods

Ninety-four patients with active acromegaly were examined retrospectively. During the postoperative course, patients with serum sodium levels ≤ 134 mEq/L were classified into the DPH group. We compared basic clinical characteristics, tumor characteristics, and preoperative and postoperative examination findings between the DPH and non-DPH groups.

Results

DPH occurred in 39 patients (41.5%), and the lowest serum sodium levels were generally observed during postoperative days (PODs) 7–9. They needed a 3-day longer hospital stay than those without DPH. The DPH group had lower preoperative body weight and body mass index. In addition, a transient increase in body weight during PODs 5–7 occurred with a transient decrease in urinary volume in the DPH group. Preoperative and postoperative GH and insulin-like growth factor-1 levels did not differ between the two groups.

Conclusion

The findings suggested that lower preoperative weight and a postoperative transient gain in body weight are associated with an increased risk of DPH in acromegaly patients undergoing transsphenoidal surgery.

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Data availability

The data sets are not publicly available but are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Ryutaro Makino, Shingo Fujio, Tomoko Hanada, Masanori Yonenaga, Nayuta Higa, Kazunori Arita & Ryosuke Hanaya

  2. Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan

    Ryutaro Makino, Shingo Fujio, Tomoko Hanada, Shigeru Kawade & Hiroshi Hashiguchi

  3. Department of Diabetes and Endocrine Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan

    Shigeru Kawade, Hiroshi Hashiguchi & Yoshihiko Nishio

  4. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Koji Yoshimoto

Authors
  1. Ryutaro Makino
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  2. Shingo Fujio
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Contributions

All authors contributed to the study conception and design. RM, SF, TH, MY, SK, HH and NH: performed data collection and data analysis. RM, SF and KA: wrote the main manuscript text. RM and SF: prepared all figures. YN, KY and RH: supervised the study. All coauthors read, commented, and revised the manuscript.

Corresponding author

Correspondence to Shingo Fujio.

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Conflict of interest

The authors declare that there are no conflict of interest.

Ethical approval

This study was approved by the Kagoshima University Hospital Ethics Committee (Reference no. 21–0007). Study-specific informed consent was waived due to the retrospective and noninvasive nature of our study. An opt-out approach was offered to all patients.

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Makino, R., Fujio, S., Hanada, T. et al. Delayed postoperative hyponatremia in patients with acromegaly: incidence and predictive factors. Pituitary 26, 42–50 (2023). https://doi.org/10.1007/s11102-022-01288-y

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