Outcome of non-functioning pituitary adenomas that regrow after primary treatment: a study from two large UK centers

Research output: Contribution to journalArticlepeer-review

Authors

  • Metaxia Tampourlou
  • Georgia Ntali
  • Shahzada K Ahmed
  • John Ayuk
  • James V Byrne
  • Swarupsinh Chavda
  • Simon Cudlip
  • Ashley Grossman
  • Rosalind Mitchell
  • Alessandro Paluzzi
  • John AH Wass

Colleges, School and Institutes

External organisations

  • University Hospitals Birmingham NHS Foundation Trust
  • Department of Neuroradiology, John Ratcliffe Hosptial, Oxford, OX3 9DU
  • Departments of Rheumatology and Radiology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TT, UK
  • Department of Neurosurgery, John Radcliffe Hospital, Oxford, OX3 9DU
  • Birmingham Health Partners
  • University of Oxford

Abstract

Despite the major risk of regrowth of clinically nonfunctioning pituitary adenomas (CNFAs) after primary treatment, systematic data on the probability of further tumor progression and the effectiveness of management approaches are lacking. Objective: To assess the probability of further regrowth(s), predictive factors, and outcomes of management approaches in patients with CNFA diagnosed with adenoma regrowth after primary treatment. Patients, Design, and Setting: Retrospective cohort study of 237 patients with regrown CNFA managed in two UK centers. Results: Median follow-up was 5.9 years (range, 0.4 to 37.7 years). The 5-year second regrowth rate was 35.3% (36.2% after surgery; 12.5% after radiotherapy; 12.7% after surgery combined with radiotherapy; 63.4% with monitoring). Of those managed with monitoring, 34.8% eventually were offered intervention. Type of management and sex were risk factors for second regrowth. Among those with second adenoma regrowth, the 5-year third regrowth rate was 26.4% (24.4% after surgery; 0% after radiotherapy; 0% after surgery combined with radiotherapy; 48.3% with monitoring). Overall, patients with a CNFA regrowth had a 4.4% probability of a third regrowth at 5 years and a 10.0% probability at 10 years; type of management of the first regrowth was the only risk factor. Malignant transformation was diagnosed in two patients. Conclusions: Patients with regrown CNFA after primary treatment continue to carry considerable risk of tumor progression, necessitating long-term follow-up. Management approach to the regrowth was the major factor determining this risk; monitoring had >60% risk of progression at 5 years, and a substantial number of patients ultimately required intervention.

Details

Original languageEnglish
Pages (from-to)1889–1897
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number6
Early online date2 Mar 2017
Publication statusPublished - 1 Jun 2017