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Management of Recurrent Pituitary Adenomas
by Nicholas T. Zervas, M.D.

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In reviewing 1300 patients with pituitary tumor referred to this center, recurrent pituitary adenomas comprise a significant fraction of patients.

Recurrent pituitary adenomas can result in the re-emergence of visual problems, memory loss, loss of pituitary function. In the case of Cushing's disease, the recurrence of Cushing's disease. In the case of acromegaly, the recurrence of acromegaly. In the case of prolactinoma, in the recurrence hyperprolactinema or high prolactin and of symptoms associated with that problem.

In the cases referred to this institution, patients were treated with either surgical decompression, surgical decompression and radiation therapy, or surgical decompression and proton beam irradiation. In some cases radiation alone was used.

Overall control rates in macroadenoma were 89%. In Cushings disease the control rate for recurrent adenomas was 63%. Overall control rates in acromegaly were 73% and overall control rates in hyperprolactinemia were 91%. There was no operative mortality or morbidity in the group of recurrent pituitary tumors. And all were able to return to their previous employment. Cerebrospinal fluid rhinorrhea did occur and was treated successfully.

The conclusion is that recurrent pituitary adenomas require very careful study to determine the proper course of therapy. However, recurrent pituitary tumors can almost certainly be well treated. The most vexing problem, however, is the management of recurrent Cushings disease in which total control cannot be obtained simply by re-operation alone in almost half the cases.

Proton beam radiosurgery for recurrent pituitary adenomas is probably the best form of therapy for those patients who qualify for this unique form of treatment.

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