Water and Sodium Disorders in Children Undergoing Surgical Treatment of Brain Thmorst

PARAV EE HIRANRAT , MD, MSc*, PISUT KATAVETIN,MD**, VICHIT SUPORNSILCHAI, MD*, SUTTIPONG WACHARASINDHU, MRCP (UK)*, SUMARLEE SRIVUTHANA, MD*

Affiliation : * Endocrine unit, Department of Pediatrics, ** Nephrology unit, Department of Medicine, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand. t Portions of the data included in this paper were presented in abstract form at the 55'h Thai Congress of Pediatrics held in Chiang Mai on December 4'h-6'h, 2002.

AbstractBackground : Many children with brain tumors have abnormalities in water and sodium homeostasis, such as diabetes insipidus (Dl), the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting syndrome (CSW), either pre-operatively or post-opera tively. But little data have been published on the incidence, time of onset and clinical course of water and sodium disorders in children with brain tumors.
Objectives : To characterize the water and sodium disorders in children undergoing surgical treatment for brain tumors
Patients and
Method : The medical records of children with brain tumors admitted for sur gery at King Chulalongkom Memorial Hospital from January 1997 to December 2002 were retrospec tively reviewed.
Results : There were 79 patients, 46 males and 33 females included in this study. Water and sodium disorders occurred in 36 patients (45.57%), 23 patients had DI, 12 patients had SIADH and 1 patient had cerebral salt wasting syndrome (CSW). Nine of the 36 patients had pre-operative onset of water and sodium disorders (8 DI and 1 SIADH). The development of DI and SIADH was associated with the location of the brain tumors. Patients with sellar and suprasellar tumors had the highest inci dence of DI (75.86% ). Patients with tumors of the cerebral hemispheres had the highest incidence of SIADH (44.44%). Onset of post-operative DI ranged from 2 to 19 hours (mean 9.68 hours) and most patients developed SIADH within 24 hours post-operatively.
Conclusions : DI and SIADH are common problems in children with brain tumors, especially after surgical treatment and the onset usually occurs within 24 hours after surgery. Patients with sellar and suprasellar tumors are more likely to have DI, patients with tumors of cerebral hemispheres and posterior fossa tumors are more likely to have SIADH.

Keywords : Diabetes Insipidus, Inappropriate Antidiuretic Homone Secretion, Cerebral Salt Wasting, Brain Tumor

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