Pituitary · 2025
Management of water and electrolyte disorders post-pituitary adenoma surgery: experience with Tolvaptan 7.5 mg at a tertiary care centre.
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Yamichannaiah Chethan, Sheth Kaushal VinayKumar, Lila Anurag Ranjan, Sarathi Vijaya, Patil Virendra, Memon Saba Samad, Barnabas Rohit, Karlekar Manjiri, Phadte Aditya, Sharma Anima, Bandgar Tushar
Аннотация
BACKGROUND: Water and electrolyte disorders (WED) are common after pituitary surgery, increasing morbidity and hospital stay. We report our single-centre experience, with emphasis on tolvaptan use for syndrome of inappropriate antidiuresis (SIAD).
METHODS: This retrospective study analysed 82 patients with WED following pituitary adenoma surgery. Demographics, tumour features, and WED onset, duration, and management were reviewed.
RESULTS: The median age at surgery was 30 years, with female predominance (69.5%) and majority had macro adenoma (62.1%). Cushing's disease was the most common etiology (54.8%). Isolated arginine vasopressin deficiency (AVP-D) was the most frequent WED (40.2%), followed by isolated SIAD (39%), biphasic response (18.2%), triphasic response (1.2%), and cerebral salt wasting (1.2%). Median onset of AVP-D and SIAD was post-operative day 1 and 4, respectively. There was an inverse correlation (r=-0.43, 0.002) between the day of SIAD onset and its duration. Thirteen patients received 25 doses of oral tolvaptan 7.5 mg. The median baseline serum sodium at tolvaptan initiation was 127 (125-130) mEq/L with a 24-hour increment of 5 (2-9) mEq/L. Serum sodium correction did not correlate with baseline sodium at which tolvaptan was administered (r=-0.29, p = 0.15), but a trend toward higher correction with later postoperative use was observed (r = 0.34, p = 0.09). Overcorrection (> 10 mEq/L/24 h) occurred in 2 patients (15.3%), and none developed osmotic demyelination.
CONCLUSION: Tolvaptan 7.5 mg may serve as an effective alternative treatment modality in moderate-to-severe SIAD patients.
METHODS: This retrospective study analysed 82 patients with WED following pituitary adenoma surgery. Demographics, tumour features, and WED onset, duration, and management were reviewed.
RESULTS: The median age at surgery was 30 years, with female predominance (69.5%) and majority had macro adenoma (62.1%). Cushing's disease was the most common etiology (54.8%). Isolated arginine vasopressin deficiency (AVP-D) was the most frequent WED (40.2%), followed by isolated SIAD (39%), biphasic response (18.2%), triphasic response (1.2%), and cerebral salt wasting (1.2%). Median onset of AVP-D and SIAD was post-operative day 1 and 4, respectively. There was an inverse correlation (r=-0.43, 0.002) between the day of SIAD onset and its duration. Thirteen patients received 25 doses of oral tolvaptan 7.5 mg. The median baseline serum sodium at tolvaptan initiation was 127 (125-130) mEq/L with a 24-hour increment of 5 (2-9) mEq/L. Serum sodium correction did not correlate with baseline sodium at which tolvaptan was administered (r=-0.29, p = 0.15), but a trend toward higher correction with later postoperative use was observed (r = 0.34, p = 0.09). Overcorrection (> 10 mEq/L/24 h) occurred in 2 patients (15.3%), and none developed osmotic demyelination.
CONCLUSION: Tolvaptan 7.5 mg may serve as an effective alternative treatment modality in moderate-to-severe SIAD patients.