Outcomes Following Endoscopic Transsphenoidal Reoperation for Residual or Recurrent Growth-Hormone Secreting Pituitary Adenomas Causing Acromegaly

Abstract Acromegaly is a rare disease caused by a growth hormone (GH)-secreting pituitary adenoma (GHPA) and is often primarily managed with surgical resection. Optimized treatment protocols for recurrent or residual disease are not well-established, however, and may involve repeat surgery, radiotherapy, or medical management. Here, we aimed to evaluate the safety and effectiveness of reoperation for patients with residual or recurrent GHPA. A retrospective review of patients undergoing reoperation for GHPA between 2012 and 2025 was performed. Demographic variables, surgical data, and long-term outcomes were analyzed. We included all patients with GHPA undergoing reoperation for progressive or recurrent tumor on MRI following initial tumor resection, and some with persistent hormonal hypersecretion. Seventeen endoscopic endonasal transsphenoidal reoperations were performed in 16 patients with GHPA. The average age was 47.8 ± 13.0 years. Most patients had a macroadenoma (94%), and one had a microadenoma (mean diameter: 20.1 ± 9.7 mm). Eleven (65%) patients were previously treated at outside institutions. Postoperative complications were rare, with 14 (82%) patients experiencing no complications. Gross total resection was achieved in seven (47%) patients. Eleven patients (65%) received adjuvant pharmacological treatment, and four (24%) received adjuvant radiotherapy or stereotactic radiosurgery. One (6%) patient underwent a third operation. Hormonal remission was achieved in 13 (77%) patients following multimodal treatment. Transsphenoidal reoperation for complex refractory cases of acromegaly is safe and reasonably effective when combined with a plan for adjuvant multimodal treatment. Multicenter collaborations should be considered to develop optimized treatment algorithms for these challenging cases.