Is Tolvaptan in the Treatment of SIADH Following Pituitary Surgery a Right Choice?

Year 2016, , 154 - 156, 01.07.2016

Suleyman Karakose Ayse Zeynep Bal Selman Unverdi Murat Duranay

https://doi.org/10.5455/umj.20160703095035

Abstract

Background: Fluid and electrolyte disturbances, especially hyponatremia are common complications after pituitary surgeries. Syndrome of inappropriate antidiuretic hormone secretion SIADH is the leading cause of hyponatremia in hospitals. Fluid restriction is the first step in treatment of SIADH. In rare cases vasopressin receptor inhibitors might be useful for medical treatment. Case Presentation: In this paper, we present a case of SIADH after a pituitary surgery with an unpredictable effect of tolvaptan. Conclusion: Tolvaptan is the most preferred agent for the treatment of SIADH nowadays. However tolvaptan might cause unpredictable situations in the course of treatment that clinicians must be very careful and in close follow up the patient.

Keywords

Hypernatremia, hyponatremia, pituitary surgery, SIADH, tolvaptan

References

• Borges 1. Runkle I, Villabona C, Navarro A, Pose A, Formiga F, Tejedor A, et al. Treatment of hyponatremia induced by the syndrome of Inappropriate antidiuretic hormone secretion: a multidisciplinary algorithm. Nefrologia 2014;34 (4):439-50.
• Janneck M, Burkhardt T, Rotermund R, Sauer N, Flitsch J, Aberle J. Hyponatremia after trans-sphenoidal surgery. Minerva Endocrinologica 2014;39(1):27-31
• Rose BD. New approach to disturbances in the plasma sodium concentration. Am J Med 1986; 81(6):1033.
• Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med 2007; 120:1.
• Janneck M, Burkhardt T, Rotermund R, Sauer N, Flitsch J, Aberle J. Hyponatremia after trans-sphenoidal surgery. Minerva Endocrinol 2014; 39(1): 27-31.
• Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M. Prevalence, predictors and patterns of postoperativepolyuria and hyponatraemia in the immediate courseaftertranssphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf) 1999;50:431–439.
• Loh JA, Verbalis JG. Diabetes insipidus as a complication after pituitary surgery. Nat Clin Pract Endocrinol Metab 2007;3(6):489-94.
• Ghirardello S, Hopper N, Albanese A, Maghnie M. Diabetes insipidusin craniopharyngioma: postoperative management of water and electrolyte disorders. J Pediatr Endocrinol Metab 2006; 19: 413-21.
• Verbalis JG, RobinsonAG, Moses AM. Postoperative and posttraumatic diabetes insipidus. In Diabetes Insipidus in Man, Front Horm Res 1984; 13: 247