Tolvaptan Versus Fluid Restriction in the Treatment of Hyponatremia Resulting from SIADH Following Pituitary Surgery.
J Endocr Soc
; 4(7): bvaa068, 2020 Jul 01.
Article
em En
| MEDLINE
| ID: mdl-32666012
ABSTRACT
CONTEXT The relevance of hyponatremia has been acknowledged by guidelines from the United States (2013) and Europe (2014). However, treatment recommendations differ due to limited evidence. OBJECTIVE:
In hyponatremia following pituitary surgery-caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion-we compared fluid restriction with the pharmacological increase of water excretion by blocking the vasopressin 2 receptors with tolvaptan at a low and a moderate dose.DESIGN:
Prospective observational study.SETTING:
Neurosurgical Department of a University hospital with more than 200 surgical pituitary procedures per year. PATIENTS Patients undergoing pituitary surgery and developing serum sodium below 136 mmol/L. The diagnosis of SIADH was established by euvolemia (daily measurement of body weight and fluid balance), inappropriately concentrated urine (specific gravity), and exclusion of adrenocorticotropic and thyroid-stimulating hormone deficiency. INTERVENTION Patients were treated with fluid restriction (nâ =â 40) or tolvaptan at 3.75 (nâ =â 38) or 7.5 mg (nâ =â 48). MAIN OUTCOMEMEASURES:
Treatment efficacy was assessed by the duration of hyponatremia, sodium nadir, and length of hospitalization. Safety was established by a sodium increment below 10 mmol/L per day and exclusion of side effects.RESULTS:
Treatment with 7.5 mg of tolvaptan resulted in a significant attenuation of hyponatremia and in a significant overcorrection of serum sodium in 30% of patients. The duration of hospitalization did not differ between treatment groups.CONCLUSIONS:
Tolvaptan at a moderate dose is more effective than fluid restriction in the treatment of SIADH. Overcorrection of serum sodium may be a side effect of tolvaptan even at low doses.
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MEDLINE
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En
Ano de publicação:
2020
Tipo de documento:
Article