Severe Delayed Postoperative Hyponatremia in a Case of TSH-secreting Pituitary Adenoma: A Case Report

Yan Fu1,2,3#, Xiaohai Liu4#, Siran Xu1,2,3, Jie Liu1,2,3, Weiwei Zhou5, Yongzhang Luo1,2,3* and Renzhi Wang4

1The National Engineering Laboratory for Anti-Tumor Protein Therapeutics, China
2Beijing Key Laboratory for Protein Therapeutics, China
3Cancer Biology Laboratory, School of Life Sciences, Tsinghua University, China
4Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
5Department of Geriatrics, Peking University First Hospital, China
#Both authors contributed equally to this manuscript

^*Correspondance to: Yongzhang Luo 

 PDF  Full Text DOI: 10.25107/2474-1647.2678

Abstract

Transsphenoidal resection has been well accepted as the most suitable treatment for TSH-secreting pituitary adenomas. However, due to its rare incidence, appropriate clinical practice for the postsurgical management remains to be accumulated. We report here a case of a 53-year-old male patient diagnosed to have a Thyroid-Stimulating Hormone (TSH)-secreting pituitary adenoma. The tumor was successfully removed by transsphenoidal resection, and the histological examination elucidated a pituitary adenoma with TSH positive staining. The serum level of TSH restored to normal after 3 months and eMRI detection demonstrated no sign of recurrence 12 months after the surgery. Serum levels of T3, T4, FT3, FT4 and TSH were all normal during a 42-month follow-up. While notably, 8 days after the surgery, the patient underwent severe hyponatremia (lowest to 113 mmol/l Na+) with lethargy, and the serum level of Na+ was recovered to 134 mmol/l on day 11 after emergent treatment of hypertonic saline and high salt food. This case reveals the risk of postoperative hyponatremia for thyrotrophinoma patients even with a successful resection of the tumor, which emphasized the significance of combination treatments, including 1-2 weeks prolonged hospitalization, to avoid the severe threats to patients’ lives after transsphenoidal resection.

Keywords

TSH-secreting pituitary adenomas; Transsphenoidal resection; Hyponatremia

Cite the article

Fu Y, Liu X, Xu S, Liu J, Zhou W, Luo Y, et al. Severe Delayed Postoperative Hyponatremia in a Case of TSHsecreting Pituitary Adenoma: A Case Report. Clin Surg. 2019; 4: 2678..