World Journal of Endocrine Surgery

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VOLUME 12 , ISSUE 3 ( September-December, 2020 ) > List of Articles


Prolonged Hyponatremia after Pituitary Surgery: A Case Report and Literature Review

Meriem Yazidi, Marwa Ben Jemaa, Ibtissem Oueslati, Fatma Chaker, Melika Chihaoui

Keywords : Cerebral salt-wasting syndrome, Hyponatremia, Pituitary gland, Syndrome of inappropriate secretion of antidiuretic hormone, Transsphenoidal surgery

Citation Information : Yazidi M, Jemaa MB, Oueslati I, Chaker F, Chihaoui M. Prolonged Hyponatremia after Pituitary Surgery: A Case Report and Literature Review. World J Endoc Surg 2020; 12 (3):128-131.

DOI: 10.5005/jp-journals-10002-1305

License: CC BY-NC 4.0

Published Online: 02-08-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Hyponatremia is commonly seen after pituitary surgery. It generally occurs within the first week after surgery and is usually moderate and asymptomatic. However, it may be severe and prolonged in some cases. Different etiologies can explain this hyponatremia. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the most common etiologies, but other differential diagnoses must be ruled out before making this diagnosis. In this article, we present a case of prolonged hyponatremia caused by SIADH occurring after transsphenoidal surgery for a non-functioning pituitary macroadenoma. We revise the different etiologies of hyponatremia following pituitary surgery and their treatment.

  1. Verbalis JG. Management of disorders of water metabolism in patients with pituitary tumors. Pituitary 2002;5(2):119–132. DOI: 10.1023/a:1022368615879.
  2. Sata A, Hizuka N, Kawamata T, et al. Hyponatremia after transsphenoidal surgery for hypothalamo-pituitary tumors. Neuroendocrinology 2006;83(2):117–122. DOI: 10.1159/000094725.
  3. Kiran Z, Sheikh A, Momin SNA, et al. Sodium and water imbalance after sellar, suprasellar, and parasellar surgery. Endocrine practice 2017;23(3):309–317. DOI: 10.4158/EP161616.OR.
  4. Guerrero R, Pumar A, Soto A, et al. Early hyponatraemia after pituitary surgery: cerebral salt-wasting syndrome. Eur J Endocrinol 2007;156(6):611–616. DOI: 10.1530/EJE-06-0659.
  5. Taylor SL, Tyrrell JB, Wilson CB. Delayed onset of hyponatremia after transsphenoidal surgery for pituitary adenomas. Neurosurgery 1995;37(4):649–653. DOI: 10.1227/00006123-199510000-00007.
  6. Sane T, Rantakari K, Poranen A, et al. Hyponatraemia after transsphenoidal surgery for pituitary tumor. J Clin Endocrinol Metabol 1994;79(5):1395–1398. DOI: 10.1210/jcem.79.5.7962334.
  7. Barber SM, Liebelt BD, Baskin DS. Incidence, etiology and outcomes of hyponatremia after transsphenoidal surgery: experience with 344 consecutive patients at a single tertiary center. J Clin Med 2014;3(4):1199–1219. DOI: 10.3390/jcm3041199.
  8. Tomita Y, Kurozumi K, Inagaki K, et al. Delayed postoperative hyponatremia after endoscopic transsphenoidal surgery for pituitary adenoma. Acta Neurochir (Wien) 2019;161(4):707–715. DOI: 10.1007/s00701-019-03818-3.
  9. Fisher C, Ingram WR. The effect of interruption of the supraopticohypophyseal tracts on the antidiuretic, pressor and oxytocic activity of the posterior lobe of the hypophysis. Endocrinology 1936;20(6):762–768. DOI: 10.1210/endo-20-6-762.
  10. Zada G, Liu CY, Fishback D, et al. Recognition and management of delayed hyponatremia following transsphenoidal pituitary surgery. J Neurosurg 2007;106(1):66–71. DOI: 10.3171/jns.2007.106.1.66.
  11. Jahangiri A, Wagner J, Tran MT, et al. Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations. J Neurosurg 2013;119(6):1478–1483. DOI: 10.3171/2013.7.JNS13273.
  12. Cuesta M, Hannon MJ, Thompson CJ. Diagnosis and treatment of hyponatraemia in neurosurgical patients. Endocrinol Nutr 2016;63(5):230–238. DOI: 10.1016/j.endonu.2015.12.007.
  13. Palmer BF. Hyponatraemia in a neurosurgical patient: syndrome of inappropriate antidiuretic hormone secretion versus cerebral salt wasting. Nephrol Dial Transplant 2000;15(2):262–268. DOI: 10.1093/ndt/15.2.262.
  14. Cui H, He G, Yang S, et al. Inappropriate antidiuretic hormone secretion and cerebral salt-wasting syndromes in neurological patients. Front Neurosci 2019;13:1170. DOI: 10.3389/fnins.2019.01170.
  15. Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery 2009;65(5):925–935. DOI: 10.1227/01.NEU.0000358954.62182.B3.
  16. Olson BR, Rubino D, Gumowski J, et al. Isolated hyponatremia after transsphenoidal pituitary surgery. J Clin Endocrinol Metab 1995;80(1):85–91. DOI: 10.1210/jcem.80.1.7829644.
  17. Tudor RM, Thompson CJ. Posterior pituitary dysfunction following traumatic brain injury: review. Pituitary 2019;22(3):296–304. DOI: 10.1007/s11102-018-0917-z.
  18. Fraser JF, Stieg PE. Hyponatremia in the neurosurgical patient: epidemiology, pathophysiology, diagnosis, and management. Neurosurgery 2006;59(2):222–229. DOI: 10.1227/01.NEU.0000223440.35642.6E.
  19. Harrigan MR. Cerebral salt wasting syndrome: a review. Neurosurgery 1996;38(1):152–160. DOI: 10.1097/00006123-199601000-00035.
  20. Atkin SL, Coady AM, White MC, et al. Hyponatraemia secondary to cerebral salt wasting syndrome following routine pituitary surgery. Eur J Endocrinol 1996;135(2):245–247. DOI: 10.1530/eje.0.1350245.
  21. Leonard J, Garrett RE, Salottolo K, et al. Cerebral salt wasting after traumatic brain injury: a review of the literature. Scand J Trauma Resusc Emerg Med 2015;23(1):98. DOI: 10.1186/s13049-015-0180-5.
  22. Casulari LA, Costa KN, Albuquerque R, et al. Differential diagnosis and treatment of hyponatremia following pituitary surgery. J Neurosurg Sci 2004;48(1):11–18.
  23. Suarez JI, Qureshi AI, Parekh PD, et al. Administration of hypertonic (3%) sodium chloride/acetate in hyponatremic patients with symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg Anesthesiol 1999;11(3):178–184. DOI: 10.1097/00008506-199907000-00004.
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