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Cerebral salt-wasting syndrome is a term first used incorrectly in the 1950's to describe patients who, in fact, experienced the syndrome of inappropriate ADH secretion. Many authors have subsequently questioned the existence of a true cerebral salt wasting (CSW) syndrome. We have observed 4 patients who have exhibited a true sodium wasting syndrome following pituitary surgery.

Methods. All patients admitted to our ICU following pituitary surgery were studied carefully every six hours for details of sodium and water balance. In addition, all were evaluated for evidence of renal or adrenal dysfunction.

Results. 14 patients were studied over 3 years. 4 exhibited significant hyponatremia associated with natriuresis and negative water balance (see table below)

Conclusions. These data support the existence of a true CSW syndrome, characterized by polyuria and marked natriuresis associated with a hyponatremia reflecting total body sodium depletion. These features could not be explained by SIADH, DI, renal or adrenal dysfunction. Differences in the pathophysiology of this disorder mandate a unique therapeutic approach which may be essential to avoiding serious electrolyte disturbances.

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Stidham, G., Disclafani, A. & Sanford, R. CEREBRAL SALT-WASTING SYNDROME IN PEDIATRIC NEUROSURGICAL PATIENTS. Pediatr Res 21 (Suppl 4), 207 (1987).

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