What follow-up protocols should be implemented for patients treated for pituitary adenomas to monitor for recurrence or complications?

Follow-up protocols for patients treated for pituitary adenomas should include:

• Regular clinical and radiological review (active monitoring) to assess for tumour recurrence or progression, even if the patient is not currently receiving treatment.
• Assessment and monitoring for late-onset side effects of treatment, which can occur months or years after therapy. These include hypopituitarism, cognitive decline, epilepsy, visual impairment, hearing loss, and secondary tumours.
• Regular endocrine function testing, especially if the patient has received radiotherapy that may affect pituitary function.
• Referral for ophthalmological assessment if there is a risk of visual impairment.
• Referral for audiology assessment if there is a risk of hearing loss.
• Encouragement of a healthy lifestyle to reduce risks such as stroke, including exercise, healthy diet, and smoking cessation.
• Regular monitoring of blood pressure, HbA1c, and cholesterol in patients at risk of stroke.
• Consideration of neuropsychological assessment for those at risk of cognitive decline.

These follow-up measures should be individualized based on the patient's risk profile and treatment history, with findings and risks clearly documented and communicated to the patient and their carers.

References: NICE NG99