垂体促肾上腺皮质激素腺瘤术后低钠血症的特点和处理

The characteristic and treatment of hyponatremia after operation for pituitary ACTH-secreting adenoma

目的总结垂体促肾上腺皮质激素（ACTH）腺瘤术后低钠血症的诊断和治疗。方法检索北京协和医院垂体ACTH腺瘤数据库,2012年9月~2015年9月行经蝶窦入路手术的垂体ACTH腺瘤326例,查询术后出现低钠血症（Na＋〈135 mmol/L）的病例资料。结果垂体ACTH腺瘤术后出现低钠血症56例（17.2%）,男性9例（16.1%）,女性47例（83.9%）。术后内分泌激素降至缓解标准（血清皮质醇〈140 nmol/L）,56例低钠血症均发生在术后2周内,其中术后3 d内45例（13.8%）,术后6~14 d 11例（3.4%）。经补充浓氯化钠及氢化可的松后,56例病人血钠水平均恢复正常。结论垂体ACTH腺瘤术后出现低钠血症的两个高峰期为术后3 d内和术后6~14 d,故术后应注意监测血电解质水平,及时处理。

Objective To summarize the diagnosis and treatment ofhyponatremia after operation for pituitary adrenocorticotropic hormone （ACTH） adenoma. Methods Data during the period from September 2012 to September 2015 from pituitary ACTH adenoma database in Peking Union Medical College Hospital were analyzed, 326 patients undergoing surgery via transsphenoidal approach for pituitary ACTH adenoma were involved. The clinical data ofpostoperative hyponatremia （Na^＋〈135 mmol/L） were searched. Results There were 56 （17.2%） cases of hyponatremia, consisting of 9 （16.1%） males and 47 （83.9%） females. All the 56 patients got postoperative endocrine remission （compound F 〈 140 nmol/L）. Hyponatremia occurred within 2 weeks after operation. Among them, 45 （13.8%） had hyponatremia within 3 days after operation, and 11 （3.4%） within 6-14 days after operation. By using concentrated sodium chloride and hydrocortisone, 56 patients were restored to the normal level of sertma sodium. Conclusion Two peaks of hyponatremia after operation for pituitary ACTH adenoma presents at day 3 and days 6-14 after operation, blood electrolyte levels should be monitored, and the treatment should be done timely.