Recurrent non-functioning pituitary adenomas: a review on the new pathological classification, management guidelines and treatment options

  • P. D. Delgado-López
  • J. Pi-Barrio
  • M. T. Dueñas-Polo
  • M. Pascual-Llorente
  • M. C. Gordón-Bolaños
Review Article
  • 65 Downloads

Abstract

At least 50% of surgically resected non-functioning pituitary adenomas (NFPA) recur. Either early or late adjuvant radiotherapy is highly efficacious in controlling recurrent NFPA but associates potentially burdensome complications like hypopituitarism, vascular complications or secondary neoplasm. Reoperation is indicated in bulky tumor rests compressing the optic pathway. To date, no standardized medical therapy is available for recurrent NFPA although cabergoline and temozolomide show promising results. Guidelines on the management of recurrent NFPAs are now available. The new 2017 WHO pituitary tumor classification, based on immunohistochemistry and transcription factor assessment, identifies a group of aggressive NFPA variants that may benefit from earlier adjuvant therapy. Nevertheless, NFPA patients exhibit a reduced overall life expectancy largely due to hypopituitarism and treatment-related morbidity. The management of recurrent NFPA benefits from a multidisciplinary teamwork of surgeons, endocrinologists, radiation oncologists, ophthalmologists, pathologists and neuro-radiologists in order to provide individualized therapy and anticipate deterioration.

Keywords

Non-functioning pituitary adenoma Radiotherapy Recurrence Cabergoline Temozolomide Transsphenoidal approach Guidelines Transcription factor 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest regarding the content of this manuscript.

Research involving human/animal participants

No animals participated in this study.

Informed consent

No informed consent was necessary for this review. No individual patient can be identified by the content of this paper.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Servicio de NeurocirugíaHospital Universitario de BurgosBurgosSpain
  2. 2.Servicio de Endocrinología Y NutriciónHospital Universitario de BurgosBurgosSpain
  3. 3.Servicio de Oncología RadioterápicaHospital Universitario de BurgosBurgosSpain
  4. 4.Servicio de Anatomía PatológicaHospital Universitario de BurgosBurgosSpain
  5. 5.Servicio de OftalmologíaHospital Universitario de BurgosBurgosSpain

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