Nomogram prediction model for postoperative anterior pituitary dysfunction in patients with nonfunctioning pituitary adenomas: A multidimensional analysis and validation of Short-Term and Mid-to-Long-Term outcomes.

purposeTo develop and validate a nomogram for predicting postoperative anterior pituitary dysfunction (APD) in patients with nonfunctioning pituitary adenomas (NFPAs).

methodsA total of 496 NFPA patients who underwent surgery at the Second Hospital of Lanzhou University between June 2018 and June 2024 were included, of whom 305 completed mid- to long-term postoperative follow-up. Patients were randomly assigned to training and validation cohorts (8:2 ratio) and classified into APD or non-APD groups. Clinical, radiological, and pathological variables were compared between groups. Multivariate logistic regression identified independent predictors of APD, new-onset APD, new-onset ACTH axis deficiency, and APD recovery at different postoperative stages. Model performance and clinical utility were evaluated using the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow (H-L) test, and decision curve analysis (DCA).

results(1) Independent risk factors for postoperative APD included male sex, low BMI, invasive tumor, preoperative APD, and low preoperative T4 and IGF-1 indices. New-onset APD was associated with sex, pituitary stalk compression, cavernous sinus invasion, low preoperative albumin, and low IGF-1. New-onset ACTH axis deficiency was linked to preoperative systemic inflammatory response index, uric acid (UA), phosphorus, and LDL-C. APD recovery was associated with BMI and the number of preoperative APD axes (all P < 0.05). (2) Independent predictors of APD were male sex, larger tumor volume, low preoperative sodium, high apolipoprotein B, low preoperative T3 and IGF-1 indices, short-term low IGF-1, and absence of hormone replacement. New-onset APD was associated with preoperative diastolic blood pressure, tumor volume, preoperative LDL-C, and short-term low IGF-1. New-onset ACTH axis deficiency was associated with tumor size, preoperative UA, low IGF-1 index, short-term low T4, and short-term low PRL. APD recovery correlated with preoperative sodium and IGF-1 index (all P < 0.05). (3) The nomograms demonstrated good predictive ability. For short-term outcomes, the AUCs for postoperative APD, new-onset APD, new-onset ACTH deficiency, and APD recovery were 0.78 (0.80), 0.72 (0.64), 0.80 (0.63), and 0.79 (0.74), respectively. For mid- to long-term outcomes, AUCs were 0.91 (0.82), 0.84 (0.86), 0.93 (0.69), and 0.82 (0.71), respectively. All models showed good calibration (H-L test, P > 0.05), and DCA confirmed clinical usefulness across a broad threshold range.

conclusionThe proposed nomogram models reliably predict both the occurrence and recovery of APD after NFPA surgery, demonstrating strong clinical applicability.