Younger age is a risk factor for regrowth and recurrence of nonfunctioning pituitary macroadenomas: Results from a single Australian centre.
OBJECTIVE
The natural history of nonfunctioning pituitary macroadenomas (NFPMA) after surgical resection is variable, with guidelines unable to define the duration of radiological follow-up. In this first Australian series, we identify risk factors for regrowth/recurrence of NFPMA to assist with guiding recommendations for long-term follow-up.


DESIGN
Retrospective analysis of all radiotherapy-naïve cases with NFPMA resected between 1995 and 2013.


PATIENTS
One hundred and twenty-three cases had both ≥2 postoperative scans and ≥12-month follow-up.


MEASUREMENTS
Regrowth was defined as any sustained increase in diameter of residual adenoma or recurrence as any new adenoma occurring post complete resection on serial pituitary MRI.


RESULTS
Median follow-up time was 48 months (interquartile range [IQR]: 31-86). Overall regrowth/recurrence occurred in 29% (36/123). Regrowth occurred in 40% (30/76) at a median time of 44.5 months (IQR 22-80) compared to recurrence of 12.5% (6/48; P=.003), occurring at a median time of 48 months (IQR 12-96; P=.7). Further treatment was required in 66.7% and 56.7%, respectively (=1.0). Risk factors for regrowth/recurrence by multivariate analysis were presence of residual disease and younger age at presentation. The longest time for regrowth was 168 months (14 years) and recurrence 156 months (13 years).


CONCLUSIONS
Presence of postoperative residual adenoma and younger age at presentation are the main predictors of regrowth/recurrence in NFPMA. Long-term serial imaging is required to detect regrowth and recurrence in younger patients and those with residual disease. Most regrowth/recurrences will occur within 10 years of follow-up.
['Watts|Anna K|AK|http://orcid.org/0000-0002-1154-4594', 'Easwaran|Abhishek|A|', 'McNeill|Peter|P|', 'Wang|Yi Yuen|YY|', 'Inder|Warrick J|WJ|http://orcid.org/0000-0001-5078-4980', 'Caputo|Carmela|C|']
D000236:Adenoma D000367:Age Factors D000368:Aged D001315:Australia D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010911:Pituitary Neoplasms D012008:Recurrence D012189:Retrospective Studies D012307:Risk Factors
regrowth recurrence pituitary macroadenoma