Prevention of Hyponatremia After Transsphenoidal Surgery: A Systematic Review

Context: 

Pituitary adenomas are amongst the most common tumors with a low mortality rate compared to other intracranial malignancies. Delayed hyponatremia (DH) is a common finding after transsphenoidal resection (TSS), which is the basis for the management of these tumors. Although DH is one of the leading causes of readmission after TSS, no unified guidelines exist with regard to the prevention of this electrolyte disturbance.

 This study aims to evaluate and compare existing preventive protocols for DH in order to identify and signify their common grounds.

 After a search in electronic databases, including PubMed (NCBI), Embase, Scopus, and Google Scholar with the keywords of “pituitary adenoma,” “hyponatremia,” “transsphenoid surgery”, “water electrolyte balance,” “patient readmission", six original articles were included in the study.

 We found that a protocol that both identifies groups susceptible to DH (males, older individuals, and those with a lower BMI) and consists of fluid restriction, sodium supplementation, and regular serum sodium monitoring could be utilized to prevent DH in patients with pituitary adenomas after TSS.

 Further studies with a larger sample size must be conducted to compare existing protocols for preventing DH and also investigate post-surgery optimal fluid-restricted diets and corticosteroid therapy in these patients.