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Only 1 re-review was obtained, but I confirm that in my opinion the authors have addressed all of the reviewers' comments and manuscript is ready for publication.
The authors have addressed my concerns.
The authors have addressed my concerns.
The authors have addressed my concerns.
The authors have addressed my concerns.
Please address the comments of the 3 reviewers. Given the fact that Reviewer 2 has opted for Rejection, there is no guarantee your article will be Accepted.
This article explores the risk factors for hypokalemia after pituitary adenoma surgery and could appeal to neurosurgeons.
The title is novel, the conclusion is reliable, and has strong clinical relevance.
The authors need to add values of serum potassium at different time periods to enrich the article.
NA
There are limited studies to indicate that hypokalemia impacts outcomes in pituitary adenoma. The introduction only mentions the known general medical knowledge regarding hypokalemia in clinical patients and its clinical impact.
A retrospective study is performed. In properly studying hypokalemia, one would also need to capture acid/base balance, the impact of fluid shifts and the impact of renal disease on patients.
The results do not support that transspenoidal patients have hypokalemia beyond expected numbers seen in clinical patients. And for patients with hypokalemia, the clinical result is benign.
I admire the authors attempts to study an unexplored aspect of pituitary adenoma surgery but the challenge remains as to what clinical role, if any, does hypokalemia play in the management of pituitary adenoma patients. Did hypokalemia impact the outcome of patients? How many suffered significant symptoms related to hypokalemia?
The methods section lacks detail on how hypoalbuminemia was defined and measured. This information is crucial for study reproducibility.
The ROC curve analysis for age (Figure 1) is mentioned in the results but not in the methods. This analysis should be described in the methods section.
The sample size (n=168) is relatively small for a retrospective study, especially when only 18 patients developed hypokalemia. This limits the statistical power and generalizability of the findings. The authors should discuss this limitation and consider performing a power analysis.
The authors state that age and postoperative hypoalbuminemia are independent risk factors for hypokalemia. However, the biological mechanisms underlying these associations are not adequately explained. A more in-depth discussion of potential physiological pathways is needed.
The authors mention that their findings differ from some previous studies (e.g., regarding ACTH-secreting adenomas). A more thorough comparison with existing literature and potential explanations for these discrepancies should be provided.
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