ECE2017 Guided Posters Pituitary (12 abstracts)
Outcome of non-functioning pituitary adenomas that regrow after primary treatment: a study from two large specialist UK centers
Metaxia Tampourlou 1, , Georgia Ntali 3 , Shahzada Ahmed 4 , Wiebke Arlt 1, , John Ayuk 2 , James Byrne 5 , Swarupsinh Chavda 6 , Simon Cudlip 7 , Neil Gittoes 1, , Ashley Grossman 3 , Rosalind Mitchell 8 , Michael O’Reilly 1, , Alessandro Paluzzi 8 , Andrew Toogood 2 , John Wass 3 & Niki Karavitaki 1,
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; 3Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK; 4Department of Ear, Nose and Throat, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 5Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK; 6Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 7Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; 8Department of Neurosurgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Introduction: Despite the significant risk of regrowth of non-functioning pituitary adenomas (NFAs) after primary treatment, systematic data on the probability of further tumour progression and the effectiveness of management approaches are lacking.
Aims: Assess the probability of further regrowth(s), predictive factors and outcomes of management approaches in patients with NFA diagnosed with adenoma regrowth after primary treatment (surgery combined or not with radiotherapy) in two UK referral centers.
Methods: The records of the patients with NFA who during their follow-up had adenoma regrowth were reviewed. The period covered for the primary NFA surgery was between 1/1963 and 12/2011 and the follow-up period ended in 6/2016.
Results: We identified 237 patients (median follow-up after 1st regrowth of 5.9 years (range 0.4–37.7)). The 5-year 2nd 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 by monitoring, 34.8% eventually were offered intervention. Type of management and sex were risk factors for 2nd NFA regrowth, whereas age at diagnosis of primary NFA and type of adenoma immunostaining were not. Amongst those with 2nd adenoma regrowth, the 5-year 3rd regrowth rate was 26.4% (24.4% after surgery; 0.0% after radiotherapy; 0.0% after surgery combined with radiotherapy; 48.3% with monitoring). Overall, patients with a NFA regrowth had probability of a 3rd regrowth 4.4% at 5 years, and 10.0% at 10 years, and the type of management of the 1st regrowth was the only risk factor. Malignant transformation was diagnosed in two of 237 patients (one gonadotroph and one silent ACTH adenoma).
Conclusions: Patients with regrown NFA after primary treatment continue to carry considerable risk of tumour progression necessitating long-term follow-up. Management approach of the regrowth is the major factor determining this risk; monitoring alone is associated with high progression rates and a substantial number of patients will ultimately require intervention.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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