Risk factors of central diabetes insipidus after transnasal adenomectomy

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Abstract

Background: At present, surgical intervention is a major treatment strategy for pituitary adenomas. It is commonly complicated with water and electrolyte imbalance. The prevalence of post-surgical central diabetes insipidus (CDI) may amount to 30%; however, its risk factors have not been established.

Aim: To assess the rates and nosological distribution of CDI after transnasal adenomectomy and to identify its risk factors.

Materials and methods: This retrospective study included 96 patients aged 20 to 65 years (median [Q1; Q3] 43 [34.5; 53.5]), who had transnasal adenomectomy in 2010-2011 due to Cushing's disease, acromegaly, prolactinoma, non-functioning pituitary adenoma. All patients underwent clinical examination and laboratory work-up before and after surgery. Their post-surgical course was assessed for 5 to 7 years. Depending on identified manifestations, the patients were categorized into the permanent CDI (n = 15) and transient CDI (n = 34); 47 patients had no CDI.

Results: Cushing's disease (odds ratio (OR) 6.1, 95% confidence interval (CI) 2.3-16.1), secondary adrenal insufficiency (OR 6.8, 95% CI 2.618.3) and adrenocorticotropic hormone levels of < 15.8 pg/mL (OR 5.0, 95% CI 1.9-13.5), microadenoma (OR 4.5, 95% CI 1.7-11.5) promote transient postoperative CDI, whereas macroadenoma decrease this risk (OR 0.2, 95% CI 0.1-0.5). The transient CDI was also more common in patients with secondary hypothyroidism, cortisol level of<200 nmol/L, adenoma's volume at magnetic resonance imaging of < 0.83 cm3 at trend level and more rare in patients with acromegaly and loss of tropic hormones before surgery at trend level as well. No significant risk factors were identified for permanent CDI, but it could be more often associated with secondary hypothyroidism, absence of any adenoma at magnetic resonance imaging and pituitary injury during the surgery and less frequent in patients with macroadenomas at trend level.

Conclusion: The proportion of permanent postoperative CDI was 16% (95% CI 9-24), and that of the transient form 35% (95% CI 25-45). Cushing's disease, microadenoma, development of secondary adrenal insufficiency and adrenocorticotropic hormone levels of < 15.8 pg/mL after surgery increase the probability of transient CDI, whereas macroadenoma does decrease this risk. No significant risk factors were identified for permanent CDI.

About the authors

D. S. Mikhaylova

Endocrinology Research Center; Clinic К + 31

Author for correspondence.
Email: d.s.mikhaylova@mail.ru
ORCID iD: 0000-0003-2373-8043

Daria S. Mikhaylova - Postgraduate Student, Department of Neuroendocrinology and Osteopathy, Endocrinology Research Center; Endocrinologist, Clinic К + 31.

42-4 Lobachevskogo ul., Moscow, 119415.

Tel.: +7 (499) 999 31 31.

Russian Federation

L. K. Dzeranova

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0002-0327-4619

Larisa K. Dzeranova - MD, PhD, Chief Research Fellow, Department of Neuroendocrinology and Osteopathy, Scientific Secretary.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

O. Yu. Rebrova

Endocrinology Research Center; N.I. Pirogov Russian National Research Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-6733-0958

Olga Yu. Rebrova - MD, PhD, Associate Professor, Professor of Institute of Higher and Additional Professional Education, Endocrinology Research Center; Professor, Chair of Medical Cybernetics and Informatics, Medical and Biology Faculty, N.I. Pirogov Russian National Research Medical University.

11 Dmitriya Ul'yanova ul., Moscow, 117036; 1 Ostrovityanova ul., Moscow, 117997.

Russian Federation

E. A. Pigarova

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0001-6539-466X

Ekaterina A. Pigarova - MD, PhD, Leading Research Fellow, Department of Neuroendocrinology and Osteopathy, Acting Director of Institute of Higher and Additional Professional Education.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

L. Ya. Rozhinskaya

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0001-7041-0732

Liudmila Ya. Rozhinskaya - MD, PhD, Professor, Chief Research Fellow, Department of Neuroendocrinology and Osteopathy.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

E. I. Marova

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0002-5130-4157

Eugenya I. Marova - MD, PhD, Professor, Chief Research Fellow, Department of Neuroendocrinology and Osteopathy.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

V. N. Azizyan

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0001-9718-6099

Vilen N. Azizyan - MD, PhD, Neurosurgeon, Department of Neurosurgery.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

O. V. Ivashchenko

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0002-6109-7550

Oksana V. Ivashchenko - Neurosurgeon, Department of Neurosurgery.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

A. Yu. Grigoriev

Endocrinology Research Center

Email: fake@neicon.ru
ORCID iD: 0000-0002-9575-4520

Andrey Yu. Grigoriev - MD, PhD, Head of Department of Neurosurgery.

11 Dmitriya Ul'yanova ul., Moscow, 117036.

Russian Federation

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Copyright (c) 2021 Mikhaylova D.S., Dzeranova L.K., Rebrova O.Y., Pigarova E.A., Rozhinskaya L.Y., Marova E.I., Azizyan V.N., Ivashchenko O.V., Grigoriev A.Y.

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