ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This comprehensive systematic review and meta-analysis provides crucial insights into the prevalence and diagnostic challenges of central diabetes insipidus (CDI), vasopressin deficiency (AVP-D), following transsphenoidal surgery (TSS) for pituitary tumours.

Despite advances in pituitary surgery techniques, posterior pituitary dysfunction remains a common and challenging complication in immediate post-operative management (1). AVP-D is the most common water balance disorder following Transsphenoidal surgery (TSS) and can be either transient or permanent, depending on the damage to the pituitary stalk or hypothalamus. Notably, many systematic reviews and meta-analyses on AVP-D prevalence after pituitary surgery lack consistent diagnostic criteria, leading to an unclear understanding of the complication’s true extent (2,3).

This study aggregates data from 51 studies, including patients with pituitary adenomas, craniopharyngiomas, and Rathke’s cleft cysts (RCCs), which definitively shows that AVP-D has a varied incidence across these tumour types, both transient and permanent. Transient post-operative AVP-D occurred in 17% of cases and permanent AVP-D in 3%. Permanent AVP-D occurred in 30% of craniopharyngioma surgeries, 14% of RCC cases, and only 2% of pituitary adenoma surgeries. Additionally, the prevalence rates varied depending on the diagnostic criteria used for AVP-D.

This highlights the differing effects of tumour type and surgery on hypothalamic-pituitary axis integrity. Additionally, the study emphasizes the inconsistencies in diagnostic criteria for post-operative AVP-D, leading to varied prevalence rates. The authors advocate for a standardized diagnostic approach to AVP-D, emphasizing the need for consensus on criteria such as hypotonic polyuria, hypernatremia, and desmopressin administration.

This study highlights the need for standardization in diagnosing post-operative AVP-D and emphasizes the importance of early recognition and intervention to mitigate long-term complications. Further research is warranted to refine diagnostic protocols and improve patient outcomes in this complex clinical scenario.

References: 1. Hussein Z, Tzoulis P, Marcus HJ, Grieve J, Dorward N, Bouloux PM, et al. The management and outcome of hyponatraemia following transsphenoidal surgery: a retrospective observational study. Acta Neurochir (Wien). 2022;164(4):1135-44.2. Tabaee A, Anand VK, Barrón Y, Hiltzik DH, Brown SM, Kacker A, et al. Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg. 2009;111(3):545-54.3. Chen J, Liu H, Man S, Liu G, Li Q, Zuo Q, et al. Endoscopic vs. Microscopic Transsphenoidal Surgery for the Treatment of Pituitary Adenoma: A Meta-Analysis. Front Surg. 2021;8:806855.