Will pituitary tumor recur after recovery?

I believe everyone should have a certain understanding of pituitary tumors. In recent years, with the increase in incidence, the number of patients has also been increasing. Pituitary tumors are mostly benign tumors. After surgical resection, the possibility of cure is very high. So for patients, the most worrying thing is whether it will recur after cure. Let’s learn about whether pituitary tumors will recur after cure.

1. The degree of tumor resection and the amount of residual tumor are the main factors for recurrence. If the pituitary adenoma is completely removed during surgery, the possibility of recurrence is very small. If only a large part or a part of the tumor is removed, the possibility of recurrence is greater. If the tumor is invisible on postoperative imaging and the blood endocrine hormones are normal, there will be almost no recurrence. If the tumor is invasive and has no complete borders, the tumor surrounds the bilateral internal carotid arteries and invades multiple places in the bilateral cavernous sinuses, it is difficult to completely remove it by craniotomy or transsphenoidal surgery, and this type of tumor is often prone to recurrence.

2. Choice of surgical method. The surgical method should be comprehensively determined based on the volume of the tumor, the degree of invasion beyond the sellar region, and the surgeon's proficiency in various approaches. The appropriate surgical approach is extremely critical to the degree of tumor resection. Currently, the surgical approaches for pituitary adenomas are mainly transcranial and transsphenoidal. It is reported that the recurrence rate of pituitary tumors after transcranial surgery is 30%, and the recurrence rate of transsphenoidal approach is 7.75%-35%.

3. The characteristics of the tumor itself determine its recurrence. The size, texture and invasiveness of pituitary adenomas all reflect its recurrence. Pituitary adenomas are generally located in the anterior lobe. When they grow in the form of small nodules, it is the best time to perform a complete resection. If they are discovered late, when the pituitary adenoma is too large and grows above the sella turcica, the tumor will grow through the capsule or invade adjacent normal structures, making complete resection very difficult. Multiple pituitary adenomas and pituitary cell hyperplasia (nodular and diffuse hyperplasia) are also difficult to perform a complete resection.

4. Endocrine factors. About 30% of people are prone to pituitary tumors after bilateral adrenalectomy. In addition, patients with long-term primary hypothyroidism or hypogonadism often have pituitary adenomas. Therefore, the probability of recurrence in these types of pituitary tumor patients will increase further after surgery, which may be due to the long-term loss of feedback regulation.

5. Whether radiotherapy is performed after surgery for pituitary adenomas. Radiotherapy has a certain therapeutic effect on pituitary adenomas. However, the latest view is that radiotherapy can prolong the recurrence period and reduce the recurrence rate, but it cannot prevent recurrence. In view of some serious complications of postoperative radiotherapy, most scholars advocate emphasizing complete tumor resection and close postoperative follow-up for microadenomas, rather than conventional postoperative radiotherapy. For large, invasive pituitary adenomas and those with residual tumors after surgery, radiotherapy should be performed as soon as possible after surgery.

Postoperative recurrence of pituitary tumors is the result of the combined effects of multiple factors. The nature of the tumor should be fully evaluated before surgery, as much of the tumor should be removed as possible during surgery, recurrence should be predicted through pathological results after surgery, hormone monitoring and imaging review should be performed regularly, and combined with radiotherapy when necessary to prevent or reduce postoperative recurrence of pituitary tumors.