2026 Proffered Presentations
S095: RE-EVALUATING THE ROLE OF INTRAOPERATIVE CORTICOSTEROID ADMINISTRATION IN PITUITARY ADENOMA RESECTION
Danielle D Dang, MD, MA1; Andrew D Gong, MD2; Caren Stuebe, MD, MS2; Emilia Floody, MD2; Maya Parker, BS3; Callum Dewar, MD4; Purush Ramanathan, MD2; Mateo Ziu, MD, MBA2; 1Mayo Clinic Rochester; 2Inova Fairfax Medical Campus; 3University of Virginia School of Medicine; 4Walter Reed National Military Medical Center
Introduction: The role of perioperative corticosteroids in pituitary adenoma resection, particularly nonfunctioning pituitary adenomas remains controversial. Corticosteroids can be beneficial for patients with a deficient hypothalamic-piuitary axis or for perioperative benefits including antiemesis, analgesia, and mitigating airway or cerebral edema. Current CNS NFPA guidelines provide limited level III evidence for perioperative corticosteroid use in preoperative hypocortiolosemia patients, but not other patient populations.
Objectives: This study re-evaluates the role of perioperative corticosteroid administration for both nonfunctioning (NFPA) and functioning pituitary adenoma (FPA) resection with an emphasis on safety and immediate postoperative recovery outcomes.
Methods: A retrospective institutional cohort analysis was conducted of patients undergoing NFPA and FPA resection via any surgical approach over 5 years. Patients with conditions necessitating either chronic or stress-dose corticosteroids were excluded. Data on demographics, endocrine deficiencies, initial presence and improvement of neurological deficits, surgical approach, histopathology, endocrine profile, perioperative steroid administration and complications, and length of stay were collected. Univariate and multivariate analysis was used to assess the impact of perioperative steroids on postoperative outcomes for all adenoma subtypes.
Results: A total of 307 patients were screened, and 150 met inclusion criteria. Demographics, endocrine profile, adenoma subtype, and clinical presentation are reported in Figure 1. The majority were nonfunctioning macroadenomas (92.7%, p = 0.20). A total of 59 (39%) patients received perioperative corticosteroids with the most common indication being "routine" or for the purposes of enhancing post-anesthesia recovery (69.5%), followed by acute/subacute neurological deficit (18.6%), isolated hypocortisolemia (16.9%) and intrasellar hemorrhage without panhypopituitarusm (1.7%) (Figure 2). Among all patients with neurological deficits, those who received steroids demonstrated significantly greater postoperative improvement (76.7% vs 46.7%, p = 0.017), most pronounced in chronic/subacute vision loss (95.0% vs 48.0%, p = 0.0009). Notably, overall complication rates did not differ between groups (30.5% vs 25.8%, p = 0.48). The most common complications included diabetes insipidus (13.6% vs 13.2%, p = 0.64), SIADH (5.1% vs 7.7%, p = 0.64), and CSF leak (8.5% vs 3.3%, p = 0.48) (Figure 3). In univariate analysis, perioperative steroids did not correlate with increased complication rates, post-operative steroid utilization, or affect on postoperative cortisol. Use of perioperative steroids trended towards decreased LOS, but was ultimately equivalent between both groups (4 days, range 1–17 vs 1–15, p = 0.078).
Conclusion: Perioperative corticosteroid administration in pituitary adenoma resection appears safe in both NFPA and FPA patients when used for routine perioperative recovery, isolated hypocortisolemia without adrenal crisis, or preoperative neurological deficits. Steroid use was not associated with higher complication rates, particularly the incidence of adrenal shock, hyperglycemia, sinonasal wound complications, epistaxis, need for postoperative corticosteroids, or prolonged LOS, and may support improved immediate postoperative neurological recovery, particularly for vision loss of any chronicity. These findings suggest utilization of a selective, individualized approach to perioperative steroid administration in pituitary adenoma resection.
