Monitoring

The appropriate follow-up of patients with clinically nonfunctional pituitary adenomas (CNFPAs) after transsphenoidal surgery is controversial, and has limited evidence-based recommendations.[37][53]​[62][92]​​​​​​​ Patients with evidence for residual tumor after surgery need to be followed more closely. One meta-analysis pooled data from 19 studies of patients with CNFPAs after surgery, followed for a mean duration of 5.7 years: the recurrence rate was 12% in those with no evidence for residual tumor and 46% in patients with residual disease postoperatively.[93]

The recommendation for patients with pituitary microadenomas, especially with tumors <6 mm in size, is to obtain a follow-up MRI in 1 year with no further routine imaging study if the tumor is stable, unless the patient develops subsequent symptoms or signs suggestive of mass effect.[57] The Endocrine Society recommends repeating MRI in 1 year and then every 1 to 2 years for another 3 years, gradually reducing the frequency of imaging if the tumor size remains stable.[53]

Patients with nonfunctional pituitary macroadenomas need to be followed for life.

The risk of tumor growth for pituitary macroadenomas is expected to be higher because the tumor has already shown a propensity to grow. One review of 14 observational studies on patients with CNFPAs showed tumor growth, over an observation period of 1 to 8 years, in 10% of patients with microadenomas and 23% of those with macroadenomas.[56]​​

There is no consensus, but a pragmatic approach would be to obtain a follow-up MRI at 6 months and then yearly for 5 years.[57] This can be followed by an imaging study every 2 to 3 years if the pituitary tumor is stable. This recommendation is in line with that of the Endocrine Society.[53] Some of these patients may require surgical intervention and they will need close follow-up with repeated MRI scans because of a high risk of recurrence.

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