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Journal of Neurosurgical Sciences 2004 March;48(1):11-8

language: English

Differential diagnosis and treatment of hyponatremia following pituitary surgery

Casulari L. A. 1, Costa K. N. 2, Albuquerque R. C. R. 3, Naves L. A. 3, Suzuki K. 1, Dominques L. 3

1 Neurosurgery Unit Hospital de Base do Distrito Federal Escola Superior em Ciências da Saúde (­ESCS) Brasilia, Brazil
2 Intensive Care Unit Escola Superior em Ciências da Saúde (­ESCS) Brasilia, Brazil
3 Division of Endocrinology University of Brasilia, Brasilia, Brazil


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Hyponatremia is a fre­quent occur­rence ­after pitui­tary sur­gery, hav­ing ­been ­described in 9% to 35% of the ­patients. It is pro­duced by the syn­drome of inap­pro­pri­ate secre­tion of anti­diu­ret­ic hor­mone (­SIADH) or, ­more fre­quent­ly, by the cere­bral ­salt-wast­ing syn­drome (CSWS). The clin­i­cal pres­en­ta­tion of ­both syn­dromes is iden­ti­cal and the dif­fe­ren­tial diag­no­sis can be dif­fi­cult. The deter­mi­na­tion of the volem­ic ­state is essen­tial for the diag­no­sis, ­since the ­patients ­with the ­SIADH are euvo­lem­ic or hyper­vo­lem­ic, ­while ­those ­with ­CSWS are hypo­vo­lem­ic. Several meth­ods can be ­used to ­detect the volem­ic ­state in ­these ­patients and, ­among ­them, the furos­e­mide ­test can ­best dis­crim­i­nate ­between ­SIADH and ­CSWS. A furos­e­mide infu­sion (20 mg) nor­maliz­es sodi­um ser­um lev­els in ­SIADH ­patients, but not in ­CSWS ­patients who ­remain hypo­na­trem­ic. The dif­fe­ren­ti­a­tion ­between the 2 syn­dromes is clin­i­cal­ly rel­e­vant ­since ­their treat­ment is anti­thet­i­cal. ­SIADH ­patients ­need liq­uid restric­tion of liq­uids and/or furos­e­mide to ­reduce the vol­ume of extra­cel­lu­lar ­water, ­while ­CSWS ­patients ­need vol­ume replace­ment ­with sodi­um sup­ple­men­ta­tion (or flu­dro­cor­ti­sone can be a ­good alter­na­tive). The diag­no­sis and treat­ment of ­these syn­dromes are dis­cussed on the ­basis of the lit­er­a­ture ­reports.

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