Chinese researchers recommend reducing cortisol use in pituitary tumor surgery

A Chinese research team has demonstrated that withholding perioperative hydrocortisone supplementation may be safe for some patients with pituitary adenomas, reducing the unnecessary use of cortisol.

The study was conducted by researchers at the Peking Union Medical College Hospital (PUMCH) under the Chinese Academy of Medical Sciences, and was recently published in the top-tier medical journal JAMA Network Open.

Every year, about 270,000 people worldwide are diagnosed with a pituitary adenoma, the second most common type of primary brain tumor, and undergo neurological surgery.

Cortisol has been used for decades to avoid postoperative adrenal insufficiency. However, the use of cortisol can lead to many other disorders such as diabetes or electrolyte disturbance.

Recent observational studies have suggested that withholding the use of perioperative cortisol might be safe for patients with pituitary adenomas with intact hypothalamus-pituitary-adrenal (HPA) axes.

Starting in 2020, the research team from the Neurosurgery department at PUMCH conducted a randomized clinical trial involving 436 patients aged 18 to 70, all of whom had intact HPA axes and were undergoing surgery for pituitary adenomas, according to first author Guo Xiaopeng from the PUMCH.

The results showed that withholding hydrocortisone was safe and not inferior to the conventional cortisol supplementation therapy for these patients, in relation to the incidence of postoperative adrenal insufficiency, Guo said.
In addition, the incidence of diabetes or electrolyte disturbances also significantly decreased in patients who did not receive cortisol therapy, he added.