Hyponatremia is often seen after transsphenoidal surgery and is a source of considerable economic burden and patient-related morbidity and mortality. We performed a retrospective review of 344 patients who underwent transsphenoidal surgery at our institution between 2006 and 2012. Postoperative hyponatremia was seen in 18.0% of patients at a mean of 3.9 days postoperatively. Hyponatremia was most commonly mild (51.6%) and clinically asymptomatic (93.8%). SIADH was the primary cause of hyponatremia in the majority of cases (
n = 44, 71.0%), followed by cerebral salt wasting (
n = 15, 24.2%) and desmopressin over-administration (
n = 3, 4.8%). The incidence of postoperative hyponatremia was significantly higher in patients with cardiac, renal and/or thyroid disease (
p = 0.0034, Objective Risk (
OR) = 2.60) and in female patients (
p = 0.011,
OR = 2.18) or patients undergoing post-operative cerebrospinal fluid drainage (
p = 0.0006). Treatment with hypertonic saline (
OR = −2.4,
p = 0.10) and sodium chloride tablets (
OR = −1.57,
p = 0.45) was associated with a non-significant trend toward faster resolution of hyponatremia. The use of fluid restriction and diuretics should be de-emphasized in the treatment of post-transsphenoidal hyponatremia, as they have not been shown to significantly alter the time-course to the restoration of sodium balance.
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