Background Although transnasal transsphenoidal (TNTS) resection is the standard treatment for pituitary adenomas, the procedure carries a risk of hypothalamic-pituitary-adrenal (HPA) axis disruption. This potential for hypocortisolism often prompts the empiric use of perioperative steroids to mitigate hemodynamic instability. However, there is a paucity of data strictly correlating serum cortisol concentrations with intraoperative blood pressure fluctuations. This study sought to evaluate the relationship between perioperative cortisol levels, hemodynamic stability, and the necessity for vasopressors, while also examining the efficacy of prophylactic steroid administration.

Methods We conducted a prospective observational study involving 90 adult patients (aged 18–60) undergoing elective TNTS at a tertiary care center. Serial serum cortisol measurements were taken at baseline, on the morning of surgery, post-induction, post-sphenid drilling, and during episodes of refractory hypotension. Continuous hemodynamic monitoring included heart rate and arterial pressures (systolic, diastolic, and mean). Hydrocortisone prophylaxis was administered to high-risk patients or those with baseline cortisol <80 ng/ml. Statistical associations were determined using Spearman correlation and multivariate logistic regression models.

Results Our analysis revealed no statistically significant association between perioperative cortisol levels and the incidence of hypotension or vasopressor requirements across any time point. Furthermore, the administration of prophylactic hydrocortisone failed to demonstrate a reduction in the occurrence of intraoperative hemodynamic instability.

The authors have declared no competing interest.

This study was funded by academic division of Sree Chitra Tirunal Institute for Medical Sciences and Technology

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Institutional Ethics Committee of Sree Chitra Tirunal Institute for Medical Sciences and Technology

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