NCOG-24. Perioperative Steroid-Induced Hyperglycemia and Its Impact on Clinical Outcomes in Glioblastoma Patients: A Systematic Review

Abstract BACKGROUND Corticosteroids, particularly dexamethasone, are commonly used perioperatively in brain tumor patients to reduce cerebral edema and improve neurological symptoms. However, steroid-induced hyperglycemia (SIH) is a frequent adverse effect that may impact postoperative outcomes, survival, and complication rates. This systematic review examines the association between perioperative corticosteroid use, hyperglycemia, and clinical outcomes in patients undergoing brain tumor surgery. METHODS A systematic search of Embase, PubMed, Scopus, and CINAHL databases identified 3,462 records. After deduplication and screening, 40 full-text articles were reviewed, with 16 studies meeting inclusion criteria. These studies focused on adult patients undergoing brain tumor surgery and assessed the incidence, risk factors, and clinical implications of SIH, particularly in high-grade gliomas and glioblastoma. RESULTS Across studies, perioperative dexamethasone use was consistently linked to elevated blood glucose levels. Both transient and persistent hyperglycemia were associated with poorer functional recovery, increased infection rates, longer hospital stays, and reduced overall survival in glioblastoma patients. Some evidence suggests that SIH may partially mediate the negative survival outcomes associated with steroid use. Additionally, pre-existing diabetes and steroid dosing regimens were identified as key modifiers of SIH risk. CONCLUSION Steroid-induced hyperglycemia is a clinically important concern in brain tumor patients, particularly those with high-grade gliomas. Its association with adverse outcomes and reduced survival highlights the need for individualized steroid regimens, vigilant glucose monitoring, and targeted glycemic control strategies in the perioperative setting. Future prospective studies are needed to refine corticosteroid protocols that balance neurological benefit with metabolic risk. KEYWORDS Steroid-induced hyperglycemia, dexamethasone, brain tumors, glioblastoma, perioperative care, neurosurgery, glucose management, survival outcomes.