Incidence and risk factors for transient and permanent central diabetes insipidus following pituitary adenoma surgery: a single center study

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Background Diabetes insipidus (DI) is a common complication following pituitary adenoma surgery, which can adversely affect patients’ quality of life. This study aimed to clarify the types and frequency of DI in patients undergoing surgery for pituitary adenomas.Methods This retrospective cross-sectional analytical study examined a cohort of patients (n = 532) with pituitary adenomas who underwent endoscopic transsphenoidal surgery (ETSS) at Loghman Hakim Hospital between 2017 and 2023. Comprehensive data collection included demographics, hormonal profiles, magnetic resonance imaging (MRI) findings and pathology results, enabling an in-depth analysis of DI incidence and associated risk factors post-surgery. Chi-square tests and logistic regression were employed to identify factors associated with DI.Results Transient DI was most prevalent in patients with Cushing’s disease (77.8%), while permanent DI was more commonly observed in non-functional adenomas (7%). However, no significant differences in DI prevalence were identified between adenoma types (p = .57 for transient DI, p = .89 for permanent DI). Tumor size and higher preoperative sodium levels were associated with transient and permanent DI in non-functional adenomas (p = .02, p = .026) and acromegaly (p = .012). Suprasellar extension correlated with transient DI in acromegaly (p = .01), while postoperative meningitis was significantly associated with transient DI in non-functional adenomas (p = .001).Conclusion In the present study, tumor size, suprasellar extension and postoperative meningitis were linked to transient DI. In contrast, younger age, higher tumor volume and elevated mean 24-h postoperative sodium levels were associated with an increased risk of permanent DI.