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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 of hyponatremia after pituitary adrenocorticotrophic hormone (ACTH) adenoma. Methods A total of 326 cases of pituitary ACTH adenomas undergoing transsphenoidal approach were collected from Peking Union Medical College Hospital from September 2012 to September 2015. Hyponatremia (Na + 135 mmol / L) Case information. Results There were 56 cases (17.2%) of hyponatremia after operation in pituitary ACTH adenoma, including 9 males (16.1%) and 47 females (83.9%). Postoperative endocrine hormones dropped to the standard of remission (serum cortisol <140 nmol / L), 56 cases of hyponatremia occurred within 2 weeks after operation, of which 45 cases (13.8%) within 3 days after operation, postoperative 6 ~ 14 d 11 cases (3.4%). After the addition of concentrated sodium chloride and hydrocortisone, 56 patients with serum sodium levels returned to normal. Conclusions The two peak periods of hyponatremia after pituitary ACTH adenoma are 3 days after operation and 6 ~ 14 days after operation. Therefore, the level of blood electrolytes should be monitored after operation and treated promptly.