Intraoperative Predictors and Management of Pituitary Dysfunction Post-Surgery

In adults undergoing transsphenoidal surgery for non‑functioning pituitary adenomas, relative intraoperative hypotension and early postoperative rises in brain‑injury biomarkers (GFAP, NfL, tau) were associated with new anterior pituitary hormone deficiencies at 12 months. These results suggest that intraoperative hemodynamics and perioperative biomarker surveillance can inform early endocrine risk stratification and should prompt targeted postoperative endocrine follow‑up.

The prospective cohort enrolled adults having surgery for non‑functioning pituitary adenomas and used new anterior pituitary hormone deficiencies at 12 months as the primary endpoint. Investigators measured plasma GFAP, NfL, and tau preoperatively and on postoperative days 1 and 5, and characterized intraoperative blood pressure using absolute and relative MAP thresholds. By linking intraoperative physiology with circulating CNS‑injury biomarkers, the study advances an integrated perioperative risk framework beyond single‑axis postoperative surveillance.

Postoperative elevations in plasma GFAP, NfL, and tau correlated with new deficits across corticotropic, thyrotropic, and gonadotropic axes. The biomarker pattern plausibly reflects perioperative neuronal or glial injury affecting the pituitary stalk or gland.

Relative intraoperative hypotension—periods below patients' baseline MAP—was associated with new anterior pituitary hormone deficiency but not consistently with vasopressin (central diabetes insipidus) loss. Reduced pituitary perfusion or transient ischemia during prolonged relative hypotension are plausible mechanisms, though causality cannot be inferred from observational association alone. Clinically, the hemodynamic signal supports attention to perioperative perfusion as a potentially modifiable factor when optimizing endocrine outcomes.

Key Takeaways:

• Elevated postoperative GFAP, NfL, and tau associate with new anterior pituitary hormone deficiencies—linking perioperative brain‑injury signals to endocrine outcomes.
• Patients undergoing transsphenoidal surgery for non‑functioning pituitary adenomas, particularly those with prolonged relative intraoperative hypotension or significant biomarker rises.