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Abstract

Background & objective: Sella region tumors are among the most prevalent of all central nervous system tumors. Endoscopic transsphenoidal surgery (ETSS) for this condition can cause hypothalamic damage, potentially resulting in complications such as central diabetes insipidus (DI) after surgery. Copeptin is cleaved from the same precursor as arginine vasopressin and is released in equimolar amounts with arginine vasopressin from the posterior pituitary. This study aimed to determine the effects of fluid restriction on copeptin secretion in patients with Sella region tumors following ETSS.
Methodology: This randomized, unblinded clinical trial was conducted at the National Brain Centre Hospital during 2022. We recruited patients aged 18 years and diagnosed with Sella region tumors who underwent endoscopic transsphenoidal surgery. Copeptin was examined post-anesthesia, 3rd day, and 5th day after surgery. The incidence of postoperative diabetic insipidus was observed by monitoring the patient's health for 5 days following surgery.
Results: A total of 23 patients received their usual amount of fluids, and 25 patients had their intake of fluids limited to two-thirds of their basal requirements. Copeptin levels were higher in the fluid restriction group on days three and five, measuring 3.53 (1.34) and 4.8 (6.12) pmol/L, respectively, than in the non-restricted group, which measured 3.2 (1.74) and 2.8 (1.51) pmol/L. On day 3, the restriction group had a lower percentage of postoperative DI than the non-restricted group (18.8% (n = 9) versus 31.3% (n = 15); nonetheless, there was no statistically significant difference seen (P = 0.082). The percentage of postoperative DI on day five was also found to be similar, with a P value of 0.157 for 14.6% (n = 7) and 25% (n = 12) in the restricted and non-restricted groups, respectively.
Conclusions: Fluid restriction can enhance copeptin levels, particularly on the 5th day of treatment, and lower the risk of diabetic Insipidus in patients with Sella region tumors following endoscopic transsphenoidal surgery.
Abbreviations: AVP: arginine vasopressin, DI: Diabetes insipidus, ETSS: Endoscopic transsphenoidal surgery,
Keywords: AVP; Biomarker; Copeptin; Diabetes insipidus, Endocrine; ETSS, Fluid restriction  
Citation: Farina M, Farida R, Firdaus R, George Y, Rahmatisa D, Nadobudskaya S. Anaesth. pain intensive care 2025;29(6):476-82. DOI: 10.35975/apic.v29i6.2890
Received: June 01, 2025; Revised: July 09, 2025; Accepted: July 26, 2025