• Satoru Oshino, Youichi Saitoh, Manabu Kinoshita, Kosuke Mukai, Michio Otsuki, and Haruhiko Kishima.
• Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: s-oshino@nsurg.med.osaka-u.ac.jp.
• World Neurosurg. 2021 Sep 1; 153: e275-e281.

ObjectiveSecondary adrenal insufficiency (sAI) is a severe endocrinologic complication associated with nonfunctioning pituitary adenoma (NFPA). However, its prevalence is not simply related to tumor size. In this study, we aimed to detect the clinical characteristics of NFPAs that cause sAI.MethodsWe retrospectively investigated the clinical data of 218 patients with newly diagnosed macro NFPA between April 2011 and March 2020. The patients for whom endocrinologists had prescribed hydrocortisone after comprehensive endocrinologic evaluation were defined as having sAI. The 7 clinical factors analyzed for association with sAI were age, sex, presence of neurologic symptoms, hospitalization for emergency management of pituitary apoplexy, degree of optic chiasm compression, and Knosp grades on both sides.ResultsSeventy-three patients (33%) were classified into the sAI group. Multinomial logistic regression showed the strongest correlation between sAI and Knosp grade on the less extending side (P = 0.0001), followed by sex (male) (P = 0.0013) and pituitary apoplexy (P = 0.098). Tumors that extended bilaterally and had Knosp grades of 1-3 were frequently observed in sAI and were common in males.ConclusionsThe NFPAs that occupy the sella space and compress the walls on both sides of the cavernous sinus, but do not penetrate them, have a higher risk of developing sAI. This type is more common in males and is seen even in patients without visual field disturbances. This clinical finding will be beneficial in management of patients with NFPA.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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