Risk Factors Of Delayed Hyponatremia After Neuroendoscopic Pituitary Tumor Surgery

Objective: To analyze the risk factors of delayed hyponatremia through a retrospective study of patients with neuroendoscopic pituitary adenoma after surgery.Methods: The clinical data of 681 patients with neuroendoscopic pituitary adenoma in the First Affiliated Hospital of Xinjiang Medical University from 2017 to 2021 were collected.The data were divided into delayed hyponatremia group and normal serum sodium group according to the results of serum sodium.Results: A total of 681 PA patients were included,of which 256(37.6%)had delayed hyponatremia after operation.There were132 male patients(51.6%,132/256)and 124 female patients(48.4%,124/256).There were 9 patients with microadenomas(3.5%,9/256),165 patients with large adenomas(64.5%,165/256),and 82 patients with large adenomas(32%,82/256).There were 114 patients with hypokalemia(44.5%,114/256).There were 24 patients with postoperative diabetes insipidus(9.4,24/256).There were 50 patients(19.5%,50/256)with hypopituitarism before operation.A total of 188 patients(73.4%,188/256)were highly invasive.There were 57 patients(22.3%,57/256)with cerebrospinal fluid rhinorrhea.A total of 14 patients(5.5%,14/256)underwent intraoperative blood transfusion.There were 81 patients with functional pituitary adenoma(31.6%,81/256).There were 62 patients with hypertension(24.2%,62/256).There were 28 patients with diabetes(10.9%,28/256).A total of 46 patients(18%,46/256)underwent secondary surgery.Univariate analysis showed that age,length of hospital stay,tumor size,postoperative diabetes insipidus,tumor invasion,cerebrospinal fluid rhinorrhea,secondary surgery and operation time were risk factors for delayed hyponatremia after surgery,and there was statistical significance between the two groups(P<0.05).Multivariate logistic regression showed that age(OR=1.015,95% CI: 1.02～1.029,P=0.021),length of stay(OR=2.154,95% CI: 1.453～3.195,P=0.001),tumor invasion(OR=1.015,95% CI: 1.002～1.029,P=0.001),and operation time(OR=1.005,95% CI: 1.001～1.008,P=0.013)were independent risk factors for delayed postoperative hyponatremia.Conclusion: Delayed hyponatremia is easy to occur in patients with neuroendoscopic pituitary tumor after operation,and there are many influencing factors.For patients with advanced age,long hospitalization days,high tumor invasion,and long operation time,more attention should be paid to the management of water and electrolyte after operation.