3rd Edition of Diabetes and Endocrinology World Conference 2027

Abstract

Objective: To identify risk factors and develop validated nomograms for predicting short- and long-term anterior pituitary dysfunction (APD) following transsphenoidal surgery in patients with non-functioning pituitary adenomas (NFPA), enabling early clinical intervention.

Methods: This retrospective study analyzed 496 NFPA patients who underwent surgery at the Second Hospital of Lanzhou University (June 2018–June 2024), randomly divided into training (80%) and validation (20%) cohorts. Multivariable logistic regression identified independent predictors of APD at postoperative day 1 (POD1) and month 6 (POM6). Nomogram models were evaluated using receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow tests, and decision curve analysis (DCA).

Results: APD occurred in 68.15% (338/496) of patients at POD1, with independent predictors including male sex (OR=1.32), invasive tumor growth (OR=2.01), preoperative APD (OR=3.15), low thyroxine index (OR=1.67), and low insulin-like growth factor-1 (IGF-1) index (OR=1.89). At POM6, APD persisted in 45.25% (138/305), associated with male sex (OR=1.45), large tumor volume (OR=1.98), hyponatremia (OR=2.11), elevated apolipoprotein B (OR=1.76), low triiodothyronine index (OR=1.54), IGF-1 deficiency (OR=2.03), low POD1 IGF-1 (OR=1.89), and absence of hormone replacement therapy (OR=3.02). The POD1 model achieved AUCs of 0.80 (training) and 0.82 (validation), while the POM6 model showed AUCs of 0.91 (training) and 0.82 (validation). Both models exhibited excellent calibration (Hosmer-Lemeshow P>0.05) and DCA demonstrated sustained clinical net benefit across a broad threshold probability spectrum.

Conclusion: These nomograms provide clinicians with robust, individualized tools to predict postoperative APD risks in NFPA patients, supporting timely interventions and personalized management strategies.