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
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
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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