2026 Proffered Presentations
S040: PERIOPERATIVE GLP-1 USE IMPROVES PITUITARY FUNCTION RECOVERY AFTER ENDOSCOPIC RESECTION
Maunil Mullick1; Rahim Abo Kaseem1; Philip B Ostrov1; Arshi Kaur1; Niraj Rama1; Charles Froman-Glover1; Isaac Abecassis1; Noberto Andaluz2; Dale Ding1; A Mistry1; Brian Williams1; 1University of Louisville; 2University of Cincinnati
Objective: To evaluate the impact of perioperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use on outcomes in patients undergoing endoscopic transsphenoidal resection of benign pituitary tumors.
Background: GLP-1 RAs are increasingly prescribed for type 2 diabetes mellitus and weight management, with mounting evidence for their perioperative benefits. Large surgical cohorts have demonstrated reduced readmission, wound complications, and hematoma rates among GLP-1 RA users. Orthopedic studies report improved postoperative infection and revision rates in obese and diabetic patients undergoing spinal fusion, while systematic reviews highlight perioperative glycemic stability with reduced insulin requirements. However, concerns remain regarding delayed gastric emptying and hypoglycemia. Beyond metabolic control, GLP-1 RAs may confer neuroprotective effects, with emerging evidence suggesting relevance to neurological and neurosurgical populations. Despite these findings, little is known regarding their effect in pituitary surgery, where endocrine comorbidities and neurohormonal recovery are central to outcomes.
Methods: We retrospectively queried the TriNetX Global Collaborative Network to identify adults (≥18 years) who underwent primary endoscopic transsphenoidal resection of benign pituitary tumors between January 2011 and December 2024. Patients with a history of craniotomy or GLP-1 RA use outside the perioperative window were excluded. Two cohorts were defined, those receiving perioperative GLP-1 RA and those without exposure. Outcomes were selected according to the PitCOP Collaborators Delphi study. Propensity score matching (PSM) was performed using a 1:1 greedy nearest-neighbor algorithm without replacement. Covariate balance was achieved with standardized mean differences <0.1 across all variables (Figure 1).
Results: Of 11,497 identified patients, 11,231 met inclusion criteria, with 555 exposed to perioperative GLP-1 receptor agonists and 10,676 serving as controls. Propensity score matching based on demographics, comorbidities, endocrine diagnoses, medications, and laboratory values yielded 506 matched pairs. Before matching, GLP-1 RA patients demonstrated higher rates of diabetes, obesity, and elevated BMI.
Following PSM, the GLP-1 RA cohort demonstrated significantly higher rates of postoperative recovery or improvement in pituitary function compared to controls (RR 1.29, p=0.037), corresponding to a 5.3% absolute risk reduction and a number needed to treat of 19. No other statistically significant differences were observed between groups for short-term surgical, recovery, nasal, ophthalmic, or reoperation outcomes after matching (Table 1).
Conclusions: Perioperative GLP-1 RA exposure was not associated with increased risk of short-term surgical morbidity, recovery indices, or reoperation rates following endoscopic transsphenoidal resection of benign pituitary tumors. However, perioperative GLP-1 RA use correlated with higher rates of postoperative recovery or improvement in pituitary function, suggesting a potential disease-modifying effect on hypothalamic–pituitary axis integrity beyond established metabolic indications. These findings open the door for prospective investigation to validate the observed endocrine benefits and elucidate underlying mechanisms.
