Factors Influencing Glucocorticoid Treatment Levels Following eTSS

Overview

This study identifies key predictors of glucocorticoid therapy intensity in patients with non-functioning pituitary adenomas (NFPAs) post-endoscopic transsphenoidal surgery (eTSS). Tumor volume, suprasellar extension, pituitary stalk stretch, and preoperative morning cortisol levels were found to significantly influence glucocorticoid requirements.

Background

Non-functioning pituitary adenomas (NFPAs) are prevalent pituitary tumors that can lead to significant endocrine disturbances, particularly adrenal insufficiency, following surgical intervention. Endoscopic transsphenoidal surgery (eTSS) is the preferred treatment, yet many patients require long-term glucocorticoid therapy due to postoperative hypopituitarism.

Data Highlights

This study analyzed data from 116 patients and identified four independent predictors of glucocorticoid therapy intensity.

Key Findings

• Tumor volume is a significant predictor of glucocorticoid therapy intensity (p < 0.05).
• Suprasellar extension of the tumor correlates with increased glucocorticoid requirements (p < 0.05).
• Preoperative morning cortisol levels are an independent predictor of postoperative glucocorticoid therapy intensity (p < 0.05).
• The model developed explains 72.1% of the variance in glucocorticoid therapy intensity (adjusted R2 = 0.721).
• Bootstrap resampling confirmed the robustness of the predictive model (RMSE: 656.04; 95% CI: 637.50–690.22).

Clinical Implications

The identification of these predictors can aid clinicians in understanding glucocorticoid replacement therapy for NFPA patients post-eTSS.

Conclusion

The study provides a predictive model based on specific clinical and imaging parameters.

Related Resources & Content

1. Pituitary Society, Nature Reviews Endocrinology, 2025 -- Pituitary incidentaloma: a Pituitary Society international consensus guideline statement
2. JAMA Network, 2023 -- Safety of Withholding Perioperative Hydrocortisone for Patients With Pituitary Adenomas With an Intact Hypothalamus-Pituitary-Adrenal Axis: A Randomized Clinical Trial
3. PubMed, 2026 -- Postoperative days 1 and 2 morning cortisol levels as predictors of long-term secondary adrenal insufficiency following pituitary adenoma surgery
4. Journal of Neuro-Oncology — Strategies for Managing Patients with Persistent Cushing's Disease After Initial Treatment
5. Journal of Neuro-Oncology — Standardized Monitoring Strategies for Identifying Recurrences of Cushing’s Disease Post-Transsphenoidal Surgery
6. Assessment of Hormonal Replacement Needs Before and After Surgery for Non-Adenomatous Lesions in the Sellar and Parasellar Regions: The Role of the Sellar Encroachment Score
7. Outcomes of Transsphenoidal Pituitary Surgery: A Single-Center Study of 578 Patients in Sweden Focusing on Remission, Complications, and Survival Rates
8. Pituitary incidentaloma: a Pituitary Society international consensus guideline statement | Nature Reviews Endocrinology
9. Safety of Withholding Perioperative Hydrocortisone for Patients With Pituitary Adenomas With an Intact Hypothalamus-Pituitary-Adrenal Axis: A Randomized Clinical Trial | Surgery | JAMA Network Open | JAMA Network
10. Postoperative days 1 and 2 morning cortisol levels as predictors of long-term secondary adrenal insufficiency following pituitary adenoma surgery - PubMed
11. Glucocorticoid-Induced Adrenal Insufficiency | Endocrine Society