{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T18:24:53Z","timestamp":1783967093551,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T00:00:00Z","timestamp":1645056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Postoperative diabetes insipidus (DI) is a common complication following endoscopic sellar surgery. However, the requirement of desmopressin treatment for patients with DI are heterogenous. Although the predictors of postoperative DI have been reported, whether these patients required desmopressin treatment remained uninvestigated. Predicting the need of desmopressin can benefit clinical decision making more directly than predicting the occurence of postoperative DI. This study aimed to identify variables that predict the need for desmopressin treatment following sellar surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing endoscopic sellar surgery between 2016 and 2019 were retrospectively reviewed. Twenty-three variables, characterized as potential predictors for requiring desmopressin treatment, were analyzed. To assess the capability to generalize the identified predictors, external validation with receiver operating characteristic (ROC) analysis was performed using a second series from 2019 to 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Postoperative DI occurred in 40 of 159 included patients. Twelve patients required inpatient desmopressin treatment and 20 patients needed desmopressin prescription after discharge. The potential predictors of requiring any desmopressin use included higher peak sodium (Na) level (<jats:italic>p<\/jats:italic> = 0.007), lower minimum Na level (<jats:italic>p<\/jats:italic> = 0.043), and higher peak urine output (<jats:italic>p<\/jats:italic> = 0.006), but these were not supported by external validation. The predictors of requiring desmopressin after discharge included higher peak Na (<jats:italic>p<\/jats:italic> = 0.040) and minimum Na levels (<jats:italic>p<\/jats:italic> = 0.048), which were supported by external ROC validation showing areas under curve of 0.787, 0.611, and 0.898 for peak Na (<jats:italic>p<\/jats:italic> = 0.036), minimum Na (<jats:italic>p<\/jats:italic> = 0.460), and peak Na \u2013 minimum Na levels (<jats:italic>p<\/jats:italic> &amp;lt; 0.001), respectively. A criterion of peak Na \u2265 150 mmol\/L or peak Na \u2013 minimum Na \u2265 10 predicted the need of desmopressin prescription after discharge. A postoperative management algorithm was proposed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The required treatments for patients with postoperative DI following endoscopic sellar surgery are heterogenous. Elevated peak Na and large peak Na\u2014minimum Na levels in the perioperative period predicted requiring desmopressin after hospital discharge. Patients with peak Na &amp;lt;150 mmol\/L and peak Na\u2014minimum Na &amp;lt;10 can be safely discharged without desmopressin prescription.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2022.843646","type":"journal-article","created":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T06:07:30Z","timestamp":1645078050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Predicting the Need for Desmopressin Treatment During Inpatient and After Discharge Following Endoscopic Sellar Surgery"],"prefix":"10.3389","volume":"13","author":[{"given":"Chia-En","family":"Wong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Hsin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Ying","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Hsuan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Chen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Fang","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Shun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"555","DOI":"10.3171\/2008.9.JNS08191","article-title":"Incidence, clinical manifestations, and course of water and electrolyte metabolism disturbances following transsphenoidal pituitary adenoma surgery: A prospective observational study: Clinical article","volume":"111","author":"Kristof","year":"2009","journal-title":"J Neurosurg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1210\/js.2018-00121","article-title":"Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas","volume":"2","author":"Nayak","year":"2018","journal-title":"Journal of the Endocrine Society."},{"key":"B3","doi-asserted-by":"publisher","first-page":"448","DOI":"10.3171\/jns.2005.103.3.0448","article-title":"Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients","volume":"103","author":"Nemergut","year":"2005","journal-title":"J Neurosurg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1046\/j.1365-2265.1999.00666.x","article-title":"Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas","volume":"50","author":"Hensen","year":"1999","journal-title":"Clin Endocrinol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1007\/s11102-020-01083-7","article-title":"Postoperative diabetes insipidus: how to define and grade this complication?","volume":"24","author":"de Vries","year":"2021","journal-title":"Pituitary."},{"key":"B6","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.wneu.2017.07.175","article-title":"Physiologic mechanisms of water and electrolyte disturbances after transsphenoidal pituitary surgery","volume":"107","author":"Blair","year":"2017","journal-title":"World Neurosurg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1227\/01.NEU.0000311063.10745.D8","article-title":"Predictors and incidence of central diabetes insipidus after endoscopic pituitary surgery","volume":"62","author":"Sigounas","year":"2008","journal-title":"Neurosurgery."},{"key":"B8","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1093\/neuros\/nyaa148","article-title":"Diabetes insipidus after endoscopic transsphenoidal surgery","volume":"87","author":"Burke","year":"2020","journal-title":"Neurosurgery."},{"key":"B9","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s11102-012-0453-1","article-title":"Post-operative diabetes insipidus after endoscopic transsphenoidal surgery","volume":"16","author":"Schreckinger","year":"2013","journal-title":"Pituitary."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1515\/jpem-2021-0305.","article-title":"Evaluating a standardized protocol for the management of diabetes insipidus in pediatric neurosurgical patients","author":"Mak","year":"2021","journal-title":"J Pediatr Endocrinol Metab."},{"key":"B11","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1159\/000410111","article-title":"Postoperative and post-traumatic diabetes insipidus. 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