- Hypothalamus and pituitary gland
- Preoperative Serum Copeptin Can Predict Delayed Hyponatremia after Pituitary Surgery in the Absence of Arginine Vasopressin Deficiency
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Ho Kang, Seung Shin Park, Yoo Hyung Kim, Hwan Sub Lim, Mi-Kyeong Lee, Kyoung-Ryul Lee, Jung Hee Kim, Yong Hwy Kim
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Endocrinol Metab. 2024;39(1):164-175. Published online January 3, 2024
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DOI: https://doi.org/10.3803/EnM.2023.1792
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 Abstract
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- Background
Delayed postoperative hyponatremia (DPH) is the most common cause of readmission after pituitary surgery. In this study, we aimed to evaluate the cutoff values of serum copeptin and determine the optimal timing for copeptin measurement for the prediction of the occurrence of DPH in patients who undergo endoscopic transsphenoidal approach (eTSA) surgery and tumor resection.
Methods
This was a prospective observational study of 73 patients who underwent eTSA surgery for pituitary or stalk lesions. Copeptin levels were measured before surgery, 1 hour after extubation, and on postoperative days 1, 2, 7, and 90.
Results
Among 73 patients, 23 patients (31.5%) developed DPH. The baseline ratio of copeptin to serum sodium level showed the highest predictive performance (area under the curve [AUROC], 0.699), and its optimal cutoff to maximize Youden’s index was 2.5×10–11, with a sensitivity of 91.3% and negative predictive value of 92.0%. No significant predictors were identified for patients with transient arginine vasopressin (AVP) deficiency. However, for patients without transient AVP deficiency, the copeptin-to-urine osmolarity ratio at baseline demonstrated the highest predictive performance (AUROC, 0.725). An optimal cutoff of 6.5×10–12 maximized Youden’s index, with a sensitivity of 92.9% and a negative predictive value of 94.1%.
Conclusion
The occurrence of DPH can be predicted using baseline copeptin and its ratio with serum sodium or urine osmolarity only in patients without transient AVP deficiency after pituitary surgery.
- Hypothalamus and Pituitary Gland
- Advances in Pituitary Surgery
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Yoon Hwan Byun, Ho Kang, Yong Hwy Kim
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Endocrinol Metab. 2022;37(4):608-616. Published online August 19, 2022
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DOI: https://doi.org/10.3803/EnM.2022.1546
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Abstract
PDFPubReader ePub
- Pituitary surgery has advanced considerably in recent years with the exploration and development of various endoscopic approaches and techniques. Different endoscopic skull base approaches are being applied to access sellar tumors in different locations. Moreover, extracapsular dissection and cavernous sinus exploration have enabled gross total resection of sellar tumors where it could not have been achieved in the past. Techniques for skull base reconstruction have also progressed, allowing surgeons to remove larger and more complicated tumors than before. This review article discusses different endoscopic skull base approaches, surgical techniques for removing pituitary adenomas, and reconstruction methods for repairing postoperative low-flow and high-flow cerebrospinal fluid leakage.
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Citations
Citations to this article as recorded by  - Serum and hair steroid profiles in patients with nonfunctioning pituitary adenoma undergoing surgery: A prospective observational study
Seung Shin Park, Yong Hwy Kim, Ho Kang, Chang Ho Ahn, Dong Jun Byun, Man Ho Choi, Jung Hee Kim
The Journal of Steroid Biochemistry and Molecular Biology.2023; 230: 106276. CrossRef - Pituitary disease and anaesthesia
Kim Rhodes, Robert John, Astri Luoma
Anaesthesia & Intensive Care Medicine.2023; 24(6): 348. CrossRef - Орфанні ендокринні захворювання: сучасні тенденції хірургічного лікування в Україні
M.D. Tronko, B.B. Guda
Endokrynologia.2022; 27(4): 287. CrossRef
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