Endocrinol Metab.  2017 Dec;32(4):426-433. 10.3803/EnM.2017.32.4.426.

Factors Associated with Postoperative Diabetes Insipidus after Pituitary Surgery

• Faltado AL
• Macalalad-Josue AA
• Li RJ
• Quisumbing JPM
• Yu MG
• Jimeno CA

• KMID: 2406186
• DOI: http://doi.org/10.3803/EnM.2017.32.4.426

Abstract

BACKGROUND
Determining risk factors for diabetes insipidus (DI) after pituitary surgery is important in improving patient care. Our objective is to determine the factors associated with DI after pituitary surgery.
METHODS
We reviewed records of patients who underwent pituitary surgery from 2011 to 2015 at Philippine General Hospital. Patients with preoperative DI were excluded. Multiple logistic regression analysis was performed and a predictive model was generated. The discrimination abilities of the predictive model and individual variables were assessed using the receiving operator characteristic curve.
RESULTS
A total of 230 patients were included. The rate of postoperative DI was 27.8%. Percent change in serum Na (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.15 to 1.69); preoperative serum Na (OR, 1.19; 95% CI, 1.02 to 1.40); and performance of craniotomy (OR, 5.48; 95% CI, 1.60 to 18.80) remained significantly associated with an increased incidence of postoperative DI, while percent change in urine specific gravity (USG) (OR, 0.53; 95% CI, 0.33 to 0.87) and meningioma on histopathology (OR, 0.05; 95% CI, 0.04 to 0.70) were significantly associated with a decreased incidence. The predictive model generated has good diagnostic accuracy in predicting postoperative DI with an area under curve of 0.83.
CONCLUSION
Greater percent change in serum Na, preoperative serum Na, and performance of craniotomy significantly increased the likelihood of postoperative DI while percent change in USG and meningioma on histopathology were significantly associated with a decreased incidence. The predictive model can be used to generate a scoring system in estimating the risk of postoperative DI.

Keyword

Diabetes insipidus; Vasopressins; Neurosurgery; Postoperative complications; Neuroendocrinology

MeSH Terms

Area Under Curve
Craniotomy
Diabetes Insipidus*
Discrimination (Psychology)
Hospitals, General
Humans
Incidence
Logistic Models
Meningioma
Neuroendocrinology
Neurosurgery
Patient Care
Postoperative Complications
Risk Factors
Specific Gravity
Vasopressins
Vasopressins

Figure

• 

  Fig. 1 Receiver operator characteristic (ROC) curves of various laboratory parameters. (A) Preoperative sodium. (B) Preoperative urine specific gravity. (C) Percent change in sodium. (D) Percent change in urine specific gravity.

• 

  Fig. 2 Receiver operator characteristic (ROC) curve of the predictive model.

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