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Updated: Sep 11, 2025

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Management of Recurrent and Aggressive Non-Functioning Pituitary Adenomas.

Nicole A Hefner1, Odelia Cooper2

  • 1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Journal of Clinical Medicine
|August 14, 2025
PubMed
Summary

Aggressive non-functioning pituitary adenomas (NFPAs) pose treatment challenges. This review guides specialists on managing recurrent or aggressive NFPAs, exploring surgical, radiotherapy, and investigational non-surgical options.

Keywords:
dopamine agonistimmune checkpoint inhibitornonfunctioning pituitary adenoma (NFPA)peptide receptor radionuclide therapysomatostatin receptor ligand (SRL)temozolomidevascular endothelial growth factor (VEGF) inhibitor

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Area of Science:

  • Neuroendocrinology
  • Oncology

Background:

  • Non-functioning pituitary adenomas (NFPAs) can recur or behave aggressively after initial treatment.
  • Up to 47% of patients with residual tumors may experience recurrence or progression, necessitating further intervention.

Purpose of the Study:

  • To review current evidence for managing recurrent or aggressive NFPAs.
  • To provide guidance for pituitary endocrinologists and neuro-oncologists on treatment escalation.

Main Methods:

  • Literature review of studies on aggressive and recurrent NFPAs.
  • Analysis of surgical, radiotherapy, and investigational medical therapies.

Main Results:

  • Repeat surgery is an option for select accessible tumors.
  • Radiotherapy controls tumor growth in 75% of NFPAs but carries risks.
  • Several medical therapies are under investigation, with no current approvals.

Conclusions:

  • Treatment decisions for aggressive/recurrent NFPAs require careful consideration of risks and benefits.
  • Further research into novel medical therapies is crucial for improving patient outcomes.