SUN-077 - Postoperative Diabetes Insipidus in Sellar and Suprasellar Neurosurgery: Analysis of Associated Factors in A Tertiary Care Center

Introduction: Diabetes Insipidus (DI) is a common complication following sellar and suprasellar surgeries, impacting patient recovery and morbidity. While incidence varies, identifying clinical and radiological predictors is essential for optimizing perioperative management. This study aims to identify factors associated with DI development in a tertiary hospital cohort.

Methods: We conducted a retrospective analytical study including patients who underwent neurosurgical procedures in the sellar region in the last ten years. Clinical, hormonal, and radiological variables were analyzed. Statistical significance was defined as p < 0.05.

Results: The study included 83 patients (56% female; mean age at diagnosis, 54.5 ± 14 years). The most frequent diagnoses were nonfunctioning pituitary adenomas (58.8%) and acromegaly (21.3%), followed by Cushing disease (10%), meningioma (5%), Rathke’s cleft cyst (3.8%), and craniopharyngioma (1.3%). Mean maximal tumor diameter was 3.0 cm (range, 0.4–6.1), and Knosp grade ≥ 3 was observed in 34% of patients (n = 26). Preoperative panhypopituitarism was present in 29% of the cohort. Optic chiasm compression was identified in 72.5% of patients (n = 58), and 30% (n = 24) required more than one surgical procedure, mainly because of residual tumor with persistent chiasmal compression. Postoperatively, the ACTH axis was the most frequently affected, occurring in 86% (n = 44) of all patients. Major postoperative complications (death, sinus thrombosis, hemorrhage, and stroke) were observed in 12.5% (n = 10). Among the 57 patients without preoperative panhypopituitarism, eight developed postoperative deficits. Larger tumors were significantly associated with preoperative panhypopituitarism (median 3.75 vs 2.9 cm; p = 0.001), whereas tumor size was not associated with postoperative DI (median 3.1 vs 3.05 cm; p = 0.93). Postoperative DI occurred in 36% of patients (n = 29), of whom 79% recovered within 6 months. Tumor type and postoperative panhypopituitarism were not associated with the development of DI (p = 0.126 and p=0.831, respectively). Regarding invasiveness, Knosp grade ≥ 3 was not associated with postoperative panhypopituitarism (p = 0.905), DI (p = 0.866), or the severity of postoperative complications (p = 0.696). Permanent DI was not associated with any clinical or radiological characteristics, likely reflecting the heterogeneity of cohort and small number of cases.

Conclusion: DI was one of the most frequent postoperative complications after sellar surgery. The absence of clear clinical associations with the development of DI highlights the heterogeneity of the cohort and underscores the need for larger sample sizes. Prospective studies involving more homogeneous populations are warranted to better define clinical predictors of postoperative DI in patients with sellar lesions.

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