Endocrine Abstracts

The optimal post-operative management of patients undergoing trans-sphenoidal adenomectomy for non-functioning pituitary adenoma is uncertain. Since 1994, in our centre, patients receiving immediate post-operative radiotherapy have been monitored with annual visual field assessment. Annual MRI is undertaken for 5 years if radiotherapy has not been given, followed by 2-yearly MRI continued indefinitely.

We aimed to examine the efficacy of our follow-up MRI and visual field policy in detection of significant tumour regrowth, requiring further intervention with either surgery or external beam radiotherapy.

127 (78 [61%] male) had complete follow-up data for at least 12 months (median [range] 5 [1–15] years). Median (range) age at presentation was 58 (26–83) years.

77 (61%) had minimal residual tumour post-operatively therefore did not receive radiotherapy. 10 (13%) required further surgical intervention (median [range] time 3 [0.5–14] years), 9 of whom had tumour regrowth or significant residual tumour detected during routine MRI. 25 (32%) had at least one scan omitted according to protocol, although this only affected the care of 1 patient who underwent repeat surgery following urgent MRI after visual field deterioration. All those undergoing repeat surgery received radiotherapy except one (radiotherapy refused).

Radiotherapy was arranged immediately post-operatively in 50 (39%) patients with significant residual, or cavernous sinus, disease, and later in 18 after detection of tumour regrowth on MRI (median [range] time post-operatively 4 [1.25–12] years).

4 required repeat surgery following radiotherapy; 3 following visual field deterioration on routine monitoring; 1 following tumour regrowth detected on MRI for investigation of headaches.

Our routine post-operative MRI and post-radiotherapy visual field monitoring policy is effective in detecting significant residual or regrowth of tumour requiring further intervention. Our data highlight the importance of continued monitoring, with further intervention being required even 14 years after initial surgery.