{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:51:47Z","timestamp":1785419507977,"version":"3.56.0"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Syndrome of inappropriate antidiuretic hormone secretion\u2013induced hyponatremia is a common morbidity after pituitary surgery that can be profoundly symptomatic and cause costly readmissions. The authors calculated the frequency of postoperative hyponatremia after 1045 consecutive operations and determined the efficacy of interventions correcting hyponatremia.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors performed a retrospective review of 1045 consecutive pituitary surgeries in the first 946 patients treated since forming a dedicated pituitary center 5 years ago. Patients underwent preoperative and daily inpatient sodium checks, with outpatient checks as needed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Thirty-two patients presented with hyponatremia; 41% of these patients were symptomatic. Postoperative hyponatremia occurred after 165 operations (16%) a mean of 4 days after surgery (range 0\u201328 days); 19% of operations leading to postoperative hyponatremia were associated with postoperative symptoms (38% involved dizziness and 29% involved nausea\/vomiting) and 15% involved readmission for a mean of 5 days (range 1\u201320 days). In a multivariate analysis including lesion size, age, sex, number of prior pituitary surgeries, surgical approach, pathology, lesion location, and preoperative hypopituitarism, only preoperative hypopituitarism predicted postoperative hyponatremia (p = 0.006). Of patients with preoperative hyponatremia, 59% underwent medical correction preoperatively and 56% had persistent postoperative hyponatremia. The mean correction rates were 0.4 mEq\/L\/hr (no treatment; n = 112), 0.5 mEq\/L\/hr (free water restriction; n = 24), 0.7 mEq\/L\/hr (salt tablets; n = 14), 0.3 mEq\/L\/hr (3% saline; n = 20), 0.7 mEq\/L\/hr (intravenous vasopressin receptor antagonist Vaprisol; n = 22), and 1.2 mEq\/L\/hr (oral vasopressin receptor antagonist tolvaptan; n = 9) (p = 0.002, ANOVA). While some patients received more than 1 treatment, correction rates were only recorded when a treatment was given alone.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>After 1045 pituitary operations, postoperative hyponatremia was associated exclusively with preoperative hypopituitarism and was most efficiently managed with oral tolvaptan, with several interventions insignificantly different from no treatment. Promptly identifying hyponatremia in high-risk patients and management with agents like tolvaptan can improve safety and decrease readmission. For readmitted patients with severely symptomatic hyponatremia, the intravenous vasopressin receptor antagonist Vaprisol is another treatment option.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.7.jns13273","type":"journal-article","created":{"date-parts":[[2013,8,23]],"date-time":"2013-08-23T14:04:51Z","timestamp":1377266691000},"page":"1478-1483","source":"Crossref","is-referenced-by-count":77,"title":["Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations"],"prefix":"10.3171","volume":"119","author":[{"given":"Arman","family":"Jahangiri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai T.","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liane M.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell W.","family":"Tom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Kunwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"Blevins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish K.","family":"Aghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns13273","series-title":"Hosp Pract (1995)","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3810\/hp.2012.02.942","article-title":"Evaluation of costs associated with tolvaptan-mediated hospital length of stay reduction among US patients with the syndrome of inappropriate antidiuretic hormone secretion, based on SALT-1 and SALT-2 trials","volume":"40","author":"Dasta","year":"2012"},{"key":"b2-jns13273","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1530\/EJE-06-0659","article-title":"Early hyponatraemia after pituitary surgery: cerebral salt-wasting syndrome","volume":"156","author":"Guerrero","year":"2007"},{"key":"b3-jns13273","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"363","DOI":"10.3171\/jns.1995.83.2.0363","article-title":"Delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. 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