Objective:

To identify independent predictors of postoperative glucocorticoid therapy intensity in NFPA patients by integrating imaging and endocrinological parameters and to develop a predictive model for individualized glucocorticoid replacement therapy.

Approach:

• Study Design: Retrospective analysis of 116 patients who underwent pituitary adenoma resection from March 2019 to December 2024, collecting demographic, clinical, radiological, endocrinological, and pathological data.
• Data Collection: Imaging assessments included tumor volume, pituitary stalk stretch, and suprasellar extension. Preoperative serum cortisol and ACTH levels were measured.
• Statistical Analysis: Multivariate regression analysis was performed to identify independent predictors of glucocorticoid therapy intensity.

Key Findings:

• Tumor volume, suprasellar extension, pituitary stalk stretch, and preoperative morning cortisol levels are independent predictors of glucocorticoid therapy intensity (all p < 0.05).
• These factors collectively explain 72.1% of the variance in glucocorticoid therapy intensity.

Interpretation:

The proposed model provides an evidence-based tool to optimize postoperative care for NFPA patients, potentially reducing the risk of adrenal insufficiency and overtreatment.

Limitations:

• Retrospective design may introduce biases.
• Exclusion of patients with acute pituitary apoplexy may limit generalizability.

Conclusion:

The identified predictors can aid in tailoring glucocorticoid replacement therapy for NFPA patients post-surgery.