A post-operative fluid restriction protocol reduces the incidence of delayed hyponatremia following trans-sphenoidal pituitary surgery.

Authors

Aneez Joseph, Remya Rajan, Arun Jose, Nitin Kapoor, Ari G Chacko, Krishna Prabhu, Edmond Jonathan, Shalini Nair, Pamela Christudoss, Nihal Thomas, Thomas Paul, Felix Jebasingh, Kripa Cherian, Hesarghatta Shyamasunder Asha

Published in

Endocrine. Volume 91. Issue 1. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

The study assessed the effect of a postoperative fluid restriction on the incidence of delayed hyponatremia (DH) following transsphenoidal pituitary surgery (TSS). The incidence of DH in the prospective cohort was compared to that of a published retrospective cohort from our centre managed according to the standard postoperative protocol without fluid restriction.
This prospective interventional study included patients aged ≥18 years who underwent TSS for pituitary neuroendocrine tumors (PitNETs). A structured postoperative fluid restriction of ≤1.5 L/day was implemented from post-operative day 5 (POD5) to POD14, with daily intake/output monitoring. Serum sodium was measured at defined postoperative intervals. DH incidence in the prospective cohort was compared with a previously published retrospective cohort managed without fluid restriction. Patient adherence and satisfaction were assessed using a study-specific questionnaire.
The study included 78 patients with a mean(SD) age of 42.6(11.9) years. Seventy-two (92.3%) patients had macroadenomas and 35.9% of the tumors were invasive. Twelve (15.4%) patients developed early transient AVP deficiency. Eleven (14.1%) patients developed DH between POD 5-14, compared to 36% in the retrospective cohort (p = 0.001). None in the prospective cohort required readmission or prolonged hospitalization for hyponatremia and the hyponatremia resolved with further tighter fluid restriction. Seven patients developed mild asymptomatic hypernatremia/increased serum osmolarity which resolved with relaxation of fluid intake.
A structured fluid restriction protocol of ≤1.5 L/day in the post-operative period may be safe and effective in reducing the incidence of delayed hyponatremia and readmissions following transsphenoidal pituitary surgery for PitNETs in a tropical setting.

PMID:
42842140
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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