What endocrine complications occur in the perioperative period

What endocrine complications occur in the perioperative period?

Abnormalities of fluid and sodium balance are common after TSS because of antidiuretic hormone (ADH) dysregulation from pituitary stalk and/or posterior pituitary gland manipulation. Transient diabetes insipidus (DI), caused by impaired ADH secretion, may occur in the first 1 to 2 postoperative days in ∼ 20% to 30% of TSS patients; DI presents as high-volume, and dilute, urine output (> 250 cc/hr for > 2 to 3 consecutive hours, or > 3 L/day in adults). A second phase, which typically occurs during postoperative days 5 to 10, is characterized by the syndrome of inappropriate ADH release (SIADH), during which time patients are at risk for developing hyponatremia. Very rarely, permanent DI develops (< 2%) after ADH stores are exhausted, and only if there is significant destruction (> 85%) of the hypothalamic ADH neurons. The classic triphasic, DI–SIADH–DI, response is relatively rare. More commonly, isolated SIADH occurs without antecedent DI (20%–25%) and necessitates close follow-up during the first 2 weeks after TSS. Additional new-onset pituitary hormone deficiencies are also uncommon after TSS, particularly at experienced neurosurgery centers (5% to 7%), although adrenal insufficiency should be considered in patients with early and persistent hyponatremia.


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