Mini Review - (2022) Volume 23, Issue 7
Received: 31-May-2022, Manuscript No. IPP-22-14215; Editor assigned: 02-Jun-2022, Pre QC No. IPP-22-14215(PQ); Reviewed: 23-Jun-2022, QC No. IPP-22-14215; Revised: 29-Jun-2022, Manuscript No. IPP-22-14215(R); Published: 06-Jul-2022, DOI: 10.35841/1590-8577-23.7.753
Although transient Diabetes Insipidus (DI) is the most common complication of pituitary surgery, there is no consensus on its definition. Polyuria is the most overt symptoms of DI, but can also reflect several physiological adaptive mechanisms in the postoperative phase. These may be difficult to distinguish from and might coincide with DI. The difficulty to distinguish DI from other causes of postoperative polyuria might explain the high variation in incidence rates. This limits interpretation of outcomes; in particular complication rates between centers, and may lead to unnecessary treatment. Aim of this review is to determine a pathophysiologically sound and practical definition of DI for uniform outcome evaluations and treatment recommendations.
Pancreas, Pancreatitis, Diabetes Insipidus, Pancreatectomy
Excessive thirst and/or hyperosmolality or hypernatremia are the greatest markers for distinguishing pathophysiological symptoms and signs of DI from other causes. DI is distinguished from osmotic diuresis by urine osmolality.
This study contains real data and our center's expertise, as well as a review of the literature on pathophysiological causes and terminology utilised in clinical trials reporting postoperative DI [1].
Low-Grade Gliomas (LGG) are the most prevalent kind of paediatric primary central nervous system malignancy. The significance of the mitogen-activated protein kinase pathway in tumour progression is becoming clearer, and MEK inhibitors are being tested in therapeutic studies for refractory and unresectable LGGs. Drug toxicity has been observed as MEK inhibitors go through clinical studies. We present two young patients with LGG and known diabetes insipidus who experienced severe hyponatraemia after initiating trametinib, which was accompanied with large reductions in desmopressin dosages. We examine the interaction between MEK inhibition and aquaporin channel physiology to review potential mechanisms for this sodium imbalance. We propose that individuals with diabetes insipidus who have optic-hypothalamic gliomas and are starting therapy with MEK inhibitors have their serum sodium levels and clinical condition closely monitored [2].
Diabetes insipidus, which is characterised by the excretion of large amounts of dilute urine, can be fatal if not adequately identified and controlled. It is caused by one of two main defects: insufficient or impaired release of antidiuretic hormone (ADH) from the posterior pituitary gland (neurogenic or central diabetes insipidus) or insufficient or impaired renal response to ADH (nephrogenic diabetes insipidus). The difference is critical for successful therapy [3].
The surgeon faces a difficult task when dealing with pancreatic injury, and failure to handle it properly might result in serious implications for the patient. The management options for pancreatic trauma are discussed, as well as technical difficulties. External drainage can be used to treat most pancreatic injuries. Distal pancreatectomy is required for injuries to the body, neck, and tail of the pancreas, as well as suspicion or direct proof of pancreatic duct disruption. Even if there is a suspected pancreatic duct injury, similar injuries to the head of the pancreas are best handled with simple external drainage. Pancreaticoduodenectomy should be used only when the head of the pancreas has been severely injured and only as a last resort. The majority of problems should be managed with a mix of feeding at first, percutaneous drainage and endoscopic stenting. [4].
Many worries of brittle diabetes and poor quality of life, surgeons have typically been hesitant to do complete pancreatectomy (QoL). A thorough analysis is missing, although some recent studies imply that results following complete pancreatectomy have improved. Overall QoL suffers following complete pancreatectomy, owing to the significant impact of diarrhoea, which necessitates improved care [5]. To determine if proximal partial pancreatectomy (PSTP) is preferable to complete pancreatectomy (TP) in terms of preserving postoperative endocrine function, as well as to identify the pre-operative risk variables that influence prognosis following TP and PSTP [6].
Despite the fact that the literature on organ retrieval is abundant, the degree of evidence offered is often low. Optimal donor care and organ retrieval, on the other hand, should enhance the number and quality of cadaveric donor organs while also improving graft performance and survival. There is definitely opportunity for improvement in diabetes care following complete pancreatectomy, particularly in terms of preventing diabetes-related morbidity. PSTP might be a viable alternative to TP for preserving endocrine function, particularly in underweight individuals.
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Citation: Dumitrascu MM. Grade and complications in Postoperative Diabetes Insipidus in Patients after the Pancreatectomy. JOP. J Pancreas. (2022) 23:753.
Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Competing interests: The authors have declared that no competing interests exist.
