Pituitary最新文献

{"title":"Endoscopic endonasal infrachiasmatic approach to intra-third ventricle craniopharyngiomas: surgical outcomes and limits to complete resection.","authors":"Rayford Hazunga, Hiroki Morisako, Atsufumi Nagahama, Masaki Ikegami, Boon Seng Liew, Takeo Goto","doi":"10.1007/s11102-026-01729-y","DOIUrl":"10.1007/s11102-026-01729-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the surgical outcomes of the endoscopic endonasal infrachiasmatic approach (EEIA) for intra-third ventricle craniopharyngiomas (IVC) and to define the anatomical limits of tumor resection through this corridor.</p><p><strong>Methods: </strong>We retrospectively analyzed 21 cases of IVCs (17 primary and 4 recurrent) who underwent EEIA between 2016 and 2025. Clinical data were obtained from the institution's database. Surgical outcomes and anatomical limits of tumor resection were examined.</p><p><strong>Results: </strong>Gross total resection (GTR) was achieved in 18 cases and subtotal resection (STR) in 3 cases. Among patients with preoperative visual and cognitive impairment, improvements were noted in 69.2% and 88.9%, respectively. Tumor margins extending beyond the anterior suprachiasmatic limit of visualization of the infrachiasmatic corridor (IC), corresponding to the chiasma-clival line (CCL), limited safe dissection. Furthermore, tumor adherence to adjacent vasculature and mammillary bodies represented an additional limitation.</p><p><strong>Conclusion: </strong>The EEIA may enable aggressive resection of IVCs while preserving and improving visual and cognitive function. Complete resection is limited by the geometry of the operative corridor and tumor adherence to vital structures. The CCL may serve as a practical marker of the anterior suprachiasmatic limit of the corridor and aid in preoperative planning, particularly in identifying cases that may require alternative or staged approaches.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor concerning \"statistical clarification of neurological outcome estimates after pediatric suprasellar tumor surgery\".","authors":"S C Hulsmann, H M van Santen","doi":"10.1007/s11102-026-01711-8","DOIUrl":"10.1007/s11102-026-01711-8","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply to the letter to the editor by Fedai et al.: \"Long-term safety and efficacy of pegvisomant monotherapy for acromegaly: final data from the full ACROSTUDY cohort\".","authors":"Kevin C J Yuen, Sebastian Neggers, Thierry Brue","doi":"10.1007/s11102-026-01722-5","DOIUrl":"10.1007/s11102-026-01722-5","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician decision-making in non-functioning pituitary adenomas: an Australian and New Zealand interdisciplinary survey study.","authors":"Edward Mignone, Frank Saran, Alkis Psaltis, Alistair Jukes, Ryan Paul, Richard W Carroll, Peter Gorayski, Lauren Cooper, Ian Chapman, David J Torpy, Sunita Mc De Sousa","doi":"10.1007/s11102-026-01716-3","DOIUrl":"10.1007/s11102-026-01716-3","url":null,"abstract":"<p><strong>Purpose: </strong>Non-functioning pituitary adenomas (NFPA) are one of the most frequent pituitary adenoma subtypes, yet dedicated management guidelines do not exist. This study aimed to characterise real-world clinical decision-making across the spectrum of NFPA presentations and to identify areas of practice conformity versus heterogeneity within and between specialty groups.</p><p><strong>Methods: </strong>A cross-sectional, anonymous electronic survey was administered to endocrinologists, neurosurgeons, ENT surgeons, and radiation oncologists involved in pituitary adenoma care in Australia and New Zealand between January and April 2025. Three clinical scenarios were presented: an incidental microadenoma, an incidental asymptomatic macroadenoma, and a symptomatic macroadenoma with visual compromise. Concordance was defined as greater than 70% agreement on a single response within any group.</p><p><strong>Results: </strong>A total of 145 clinicians completed the survey (99 endocrinologists, 31 surgeons, 15 radiation oncologists). Areas of conformity included broad anterior pituitary hormonal evaluation, conservative management of incidental asymptomatic macroadenomas, and active intervention for symptomatic disease with visual loss. Significant heterogeneity was identified in ophthalmological assessment, repeat imaging intervals, post-operative MRI and visual field timing, and multidisciplinary team (MDT) meeting referral rates. Compared to general endocrinologists, pituitary subspecialty endocrinologists were significantly more likely to refer patients for MDT discussion and know the caseload of the surgeon to whom they were referring, and less likely to measure serum cortisol immediately post-operatively.</p><p><strong>Conclusion: </strong>This survey identifies clinically important variation in NFPA management, concentrated in domains lacking guideline recommendations. These findings highlight the need for dedicated NFPA guidelines spanning the full spectrum of NFPA presentations.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does persistent hyperprolactinemia contribute to bone loss independently of estrogen deficiency in postmenopausal women?","authors":"Ali Tunc, Ilkin Muradov, Mehmet Umut Capar, Banu Betul Kocaman, Mayis Farajli, Sebnem Yogurtcu, Oguz Alp Baykal, Sabriye Sibel Taze, Emre Durcan, Serdar Sahin, Hande Mefkure Ozkaya, Pinar Kadioglu","doi":"10.1007/s11102-026-01724-3","DOIUrl":"10.1007/s11102-026-01724-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate bone mineral density (BMD) in postmenopausal women with prolactinoma diagnosed during the premenopausal period and to compare skeletal outcomes according to prolactin status during drug-free follow-up.</p><p><strong>Methods: </strong>This retrospective cross-sectional single-center study included 42 postmenopausal women with prolactinoma. Patients were classified as hyperprolactinemic or normoprolactinemic based on serum prolactin levels at the last follow-up visit. BMD was assessed by dual-energy X-ray absorptiometry at the lumbar spine and femoral neck. Clinical variables were compared between groups. Correlation analysis, receiver operating characteristic (ROC) analysis, and multivariable logistic regression were performed.</p><p><strong>Results: </strong>Lumbar spine BMD was significantly lower in hyperprolactinemic patients than in normoprolactinemic patients (0.861 ± 0.124 vs. 0.960 ± 0.129 g/cm², p = 0.022), whereas femoral neck BMD did not differ. Patients with hyperprolactinemia had longer cumulative exposure to hyperprolactinemia and required longer and higher-dose cabergoline treatment. Baseline prolactin levels were higher in patients with osteoporosis and showed potential discriminatory value for identifying osteoporosis (AUC = 0.861). Lumbar spine BMD and T-scores were inversely correlated with prolactin levels. In multivariable analysis, baseline prolactin level remained independently associated with low BMD.</p><p><strong>Conclusion: </strong>Persistent hyperprolactinemia is associated with lower lumbar spine BMD in postmenopausal women with prolactinoma. Baseline prolactin level and cumulative exposure to prolactin excess appear to be important contributors to skeletal deterioration, supporting the need for routine bone health assessment during long-term follow-up.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gauze swabbing technique for safe dissection of pituitary tumors.","authors":"Tatsuma Matsuda, Kentaro Horiguchi, Toshiki Ishikura, Shinichi Origuchi, Yoshinori Higuchi","doi":"10.1007/s11102-026-01717-2","DOIUrl":"10.1007/s11102-026-01717-2","url":null,"abstract":"<p><strong>Objective: </strong>In endoscopic transsphenoidal surgery (ETSS) for pituitary neuroendocrine tumor (Pit-NET), also known as a pituitary adenoma, identification and dissection of the boundary between the tumor and the normal anterior pituitary gland are important surgical techniques. In this study, we introduce the Gauze Swabbing Technique (GST), in which boundary dissection is performed using shear stress, and examine its surgical outcomes.</p><p><strong>Methods: </strong>A total of 271 patients with nonfunctioning pituitary adenoma/Pit-NET who underwent ETSS at our institution between April 2014 and September 2025 were included. The patients were divided into an early group of 135 cases before the introduction of GST and a later group of 136 cases in which GST was used, and surgical outcomes were compared. Propensity score matching was performed using age, sex, tumor size, Knosp grade, tumor consistency, cavernous sinus invasion, preoperative diabetes insipidus, preoperative ocular motility disorder, and preoperative anterior pituitary dysfunction as covariates, and surgical outcomes were compared in the matched cohort by conditional logistic regression.</p><p><strong>Results: </strong>Propensity score matching yielded 100 patients in each group, and all standardized differences in background factors were less than 0.1, indicating good balance between the groups. In the post-matching comparison, there were no significant differences between the early group and the GST group in gross total resection rate, new pituitary dysfunction, new diabetes insipidus, worsening of ocular motility disorder, or intraoperative cerebrospinal fluid leakage.</p><p><strong>Conclusion: </strong>GST is a technique in which boundary dissection is performed by applying gentle shear stress through rotational movement of gauze along the interface between the tumor and the normal anterior pituitary gland, and it may enable tumor removal while preserving the membranous structure. Based on the results of the propensity score matching analysis, GST shows safety and efficacy comparable to those of conventional techniques and may be a useful option for boundary dissection in ETSS for pituitary adenoma/Pit-NET.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GH responsiveness to corticotropin-releasing hormone identifies corticotroph-like somatotroph adenomas in acromegaly.","authors":"Hirotaka Itoh, Kosuke Mukai, Yuto Mitsui, Toru Umehara, Noriyuki Kijima, Satoru Oshino, Masaharu Kohara, Eiichi Morii, Atsunori Fukuhara, Iichiro Shimomura","doi":"10.1007/s11102-026-01714-5","DOIUrl":"10.1007/s11102-026-01714-5","url":null,"abstract":"<p><strong>Purpose: </strong>Corticotropin-releasing hormone (CRH) induces an increase in growth hormone (GH) secretion in a subset of patients with acromegaly; however, the characteristics of these CRH responders remain poorly defined.</p><p><strong>Methods: </strong>22 CRH responders were retrospectively compared with 43 nonresponders.</p><p><strong>Results: </strong>CRH responders exhibited significantly larger tumors and more frequent visual field impairment than nonresponders, despite comparable baseline GH and insulin-like growth factor 1 (IGF-1) levels, and disease duration. Tumor volume and diameter were positively correlated with the GH increase ratio in CRH test, whereas GH and IGF-1 per tumor volume or diameter were significantly lower in CRH responders, indicating reduced GH secretory capacity relative to tumor size. Immunohistochemical analyses revealed higher corticotropin-releasing hormone receptor 1 (CRHR1) and lower CRHR2 expression in CRH responders. In addition, T-box transcription factor (TPIT) and adrenocorticotropic hormone (ACTH) expression were significantly more frequent in adenomas from CRH responders, suggesting a corticotroph-like phenotype. GH responses to CRH were significantly correlated with those to luteinizing hormone-releasing hormone but not thyrotropin-releasing hormone or oral glucose tolerance testing. GH responses to CRH tended to be inversely correlated with somatostatin receptor subtype 2 expression as a predictor of first-generation somatostatin receptor ligand efficacy but not with octreotide response or MRI signal intensity.</p><p><strong>Conclusions: </strong>These findings support that GH responsiveness to CRH identifies a biologically distinct subset of somatotroph adenomas characterized by corticotroph-like features, larger tumor size, and reduced GH secretory capacity. GH responsiveness to CRH may serve as a noninvasive indicator of intrinsic tumor biology and behavior.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of hypoprolactinemia on cardiometabolic effects of rosuvastatin in men: A matched Cohort Pilot Study.","authors":"Robert Krysiak, Karolina Kowalcze, Witold Szkróbka, Johannes Ott, Simona Zaami, Bogusław Okopień","doi":"10.1007/s11102-026-01721-6","DOIUrl":"10.1007/s11102-026-01721-6","url":null,"abstract":"<p><strong>Purpose: </strong>Low prolactin levels are associated with an increased risk of vascular and metabolic diseases. Women with prolactin deficiency appear to have attenuated responses to lipid-lowering and insulin-sensitizing medications. This study aimed to evaluate the impact of hypoprolactinemia on the cardiometabolic effects of rosuvastatin in men.</p><p><strong>Methods: </strong>Three groups of men with indications for statin therapy were included. Group 1 comprised 16 individuals with prolactin levels below 3 ng/mL, while groups 2 (n = 23) and 3 (n = 37) included patients with levels between 3 and 20 ng/mL. Participants in groups 1 and 2 were chronically treated with cabergoline. Throughout the six-month study period, all patients received rosuvastatin. In addition to lipid profile and prolactin levels, assessed parameters included high-sensitivity C-reactive protein (hs-CRP), fibrinogen, homocysteine, uric acid, urinary albumin-to-creatinine ratio (UACR), carbohydrate metabolism markers, testosterone, and carotid intima-media thickness (CIMT).</p><p><strong>Results: </strong>At baseline, men with hypoprolactinemia showed higher hs-CRP, fibrinogen, homocysteine, UACR, HbA_1c, and HOMA-IR, and lower testosterone than those with normal prolactin levels. Rosuvastatin reduced total and LDL cholesterol in all groups, with a greater effect in groups 2 and 3. Reductions in hs-CRP, fibrinogen, uric acid, homocysteine, and UACR occurred only in groups with normal prolactin. Group 1 exhibited increases in HbA_1c and HOMA-IR. At study end, CIMT was greater in group 1 than in groups 2 and 3, whereas the latter two groups had comparable values. In men with hypoprolactinemia, the effects of rosuvastatin on total and LDL cholesterol, hs-CRP, fibrinogen, uric acid, homocysteine, UACR, HbA_1c, HOMA-IR, and CIMT correlated with baseline and posttreatment prolactin concentrations.</p><p><strong>Conclusion: </strong>These findings suggest that hypoprolactinemia may worsen cardiometabolic outcomes in men receiving rosuvastatin therapy.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary metastasis as an endocrine-neuro-ophthalmologic emergency: clinical red flags and outcomes from a contemporary tertiary-center series.","authors":"José Calixto Llumiquinga Marcayata, Jacqueline Miyuki Viel, Matheo Augusto Morandi Stumpf, Bibiana de Souza Boger, Matheus Moreli Porceban, Mario Padula, Ericka Barbosa Trarbach, Marilena Nakaguma, Malebranche Berardo Carneiro Cunha-Neto, Rafael Loch Batista","doi":"10.1007/s11102-026-01715-4","DOIUrl":"10.1007/s11102-026-01715-4","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the clinical presentation, endocrine phenotype, and outcomes of pituitary metastasis in a contemporary tertiary-center cohort, with emphasis on clinically actionable diagnostic red flags.</p><p><strong>Methods: </strong>We conducted a retrospective single-center case series of 14 consecutive patients diagnosed with pituitary metastasis between 2010 and 2025. Presenting manifestations, endocrine features, radiologic findings, primary tumor origin, treatment patterns, and overall survival were assessed. In patients without histopathologic confirmation, diagnosis was established using the validated clinicoradiologic model proposed by Yuzkan et al. RESULTS: Median age was 52.5 years, and 71.4% of patients were women. Hypopituitarism (64.3%), arginine vasopressin deficiency (50.0%), and visual impairment (50.0%) were frequent at presentation. One patient presented with sudden bilateral visual loss and hemodynamic instability, mimicking an apoplexy-like sellar emergency. Breast cancer was the most common primary tumor (28.6%). Serum prolactin levels, available in 11 patients, were uniformly below the range typically expected for macroprolactinoma despite large sellar masses. Histopathologic confirmation was obtained in 35.7% of cases, whereas the remainder fulfilled high-likelihood clinicoradiologic criteria. Median overall survival after pituitary metastasis diagnosis was 6.5 months, and 92.9% of patients died during follow-up.</p><p><strong>Conclusion: </strong>Pituitary metastasis frequently presents with combined endocrine dysfunction and neuro-ophthalmologic compromise, occasionally as an acute sellar emergency. In oncologic patients with sellar lesions, the combination of AVP-D, visual deterioration, and non-prolactinoma-range hyperprolactinemia should raise suspicion for pituitary metastasis and prompt urgent endocrine and local evaluation.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etomidate in severe hypercortisolism: early cortisol kinetics and clinical outcomes in a real-world cohort.","authors":"Vivek Jha, Tushar Bhadada, Amal Shaharyar, Rama Walia, Sanjay Kumar Bhadada","doi":"10.1007/s11102-026-01718-1","DOIUrl":"10.1007/s11102-026-01718-1","url":null,"abstract":"<p><strong>Purpose: </strong>Severe hypercortisolism is a life-threatening endocrine emergency requiring rapid cortisol reduction. Oral steroidogenesis inhibitors may be limited in critically ill patients due to delayed onset, impaired absorption, and toxicity. Intravenous etomidate enables rapid, titratable suppression of cortisol synthesis, but data on early treatment response and real-world safety remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective study of consecutive patients with severe endogenous hypercortisolism treated with intravenous etomidate at a tertiary care centre over a 3-year period. Serum cortisol was measured at baseline and at 12 and 24 h to assess early response. Biochemical control was defined as serum cortisol < 500 nmol/L (< 18.1 µg/dL). Clinical, biochemical, and safety outcomes were analysed.</p><p><strong>Results: </strong>Ten patients [median baseline cortisol 1285 nmol/L (46.6 µg/dL)] received etomidate infusion. Serum cortisol declined early, with median reductions of 45% at 12 h and 58.5% at 24 h. Biochemical control was achieved within 24 h in 80% of patients. Response categories included rapid (30%), intermediate (50%), and delayed (20%). Patients with < 25% cortisol reduction at 12 h tended to have delayed biochemical control. Serum potassium improved during treatment and normalized before discontinuation of infusion in all patients with available serial data, while clinical stabilization was achieved in 90%. Etomidate was well tolerated; one death due to sepsis was not related to therapy.</p><p><strong>Conclusions: </strong>In this real-world cohort of patients with severe hypercortisolism, low-dose intravenous etomidate was associated with early cortisol reduction and clinically useful biochemical control in most patients. Early cortisol trajectories may help guide dose titration, but these findings should be interpreted as descriptive and hypothesis-generating because of the small sample size and retrospective design.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}