Recurrent non-functioning pituitary adenomas (NFPAs) pose a difficult challenge to neurosurgeons. NFPAs do not secrete hormones and thus symptoms usually manifest later in the disease process when the adenoma has reached a sufficient size as to cause mass effect on neighbouring bodies. Treatment of pituitary adenoma is commonly surgical with a transnasal, transsphenoidal approach. Growth of the NFPA into adjacent structures can add to the challenge of surgical resection and thus resection of NFPAs is sometimes incomplete. This often leads to recurrence and necessitates further treatment. A variety of treatment strategies may be employed to design an optimal treatment algorithm, and often a combination of these may be used depending on the size and location of the adenoma and age of the patient. This paper aims to present the evidence for each treatment strategy and to guide what the optimal treatment of NFPA may be, faced with the variety of outcomes that may arise from initial treatment.