UNILATERAL ADRENALECTOMY FOLLOWED BY PITUITARY IRRADIATION IN CUSHING'S DISEASE; WITH OBSERVATIONS ON CORTISOL SECRETION AFTER THERAPY

1965 ◽  
Vol 48 (2) ◽  
pp. 253-262 ◽  
Author(s):  
A. P. van Seters ◽  
M. Jenny ◽  
A. Querido
Keyword(s):  
Cushing’S Disease ◽  
Primary Treatment ◽  
Cushing's Disease ◽  
Cortisol Secretion ◽  
Therapeutic Result ◽  
Unilateral Adrenalectomy ◽  
Follow Up Study ◽  
Pituitary Irradiation ◽  
Secretion Rates

ABSTRACT Nineteen out of 38 patients with Cushing's disease were successfully treated by unilateral adrenalectomy and post-operative pituitary irradiation. Follow-up periods ranged from 1 to 11 years, with an average of 5.7 years. Determinations of cortisol secretion were performed in 13 patients as part of the follow-up study for the evaluation of the therapeutic result. In 11 patients, the secretion rates varied between 12.4 and 30.9 mg/24 h, values which are considered normal. Unilateral adrenalectomy followed by pituitary irradiation is advocated as the primary treatment in patients suffering from Cushing's disease without serious complications.

EVALUATION OF A THERAPEUTIC REGIMEN IN CUSHING'S DISEASE

1977 ◽  
Vol 86 (1) ◽  
pp. 146-155 ◽  
Author(s):  
S. W. J. Lamberts ◽  
F. H. de Jong ◽  
J. C. Birkenhäger
Keyword(s):  
Cushing’S Disease ◽  
Plasma Cortisol ◽  
Sella Turcica ◽  
Therapeutic Regimen ◽  
Cushing's Disease ◽  
Unilateral Adrenalectomy ◽  
Lysine Vasopressin ◽  
Pituitary Irradiation ◽  
Pituitary Adrenal Axis

ABSTRACT Eighteen unselected patients with Cushing's disease were treated by unilateral adrenalectomy followed by conventional external pituitary irradiation (4500 rads). In 9 of these patients (50 %) a remission has been reached as judged by the clinical picture and the cortisol secretion rate (CSR) up to an average of 5 years after operation (follow-up varying between 1 and 7.5 years). The 9 other patients showed a relapse making necessary a second adrenalectomy after an average of 15 months (5 to 57 months). Four of these patients had a slightly enlarged (two cases) or asymmetrical sella turcica (two cases). The gain of this therapeutic regimen was that no permanent adrenal insufficiency is induced in 50 % of the patients, that no pituitary tumours developed and that no loss of pituitary function occurred. Before treatment the group of 9 patients, who did not improve or relapsed after treatment, showed a greater rise of plasma cortisol in response to lysine vasopressin, a (greater) decrease of plasma cortisol in response to a single oral dose of 1 mg dexamethasone and an earlier decrease of the urinary 17-OGS in response to 2 mg dexamethasone four times daily orally. It is concluded that in the patients whose hypothalamo-pituitary-adrenal axis could be manipulated less this therapeutic regimen had a better result.

scholarly journals Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

2013 ◽  
Vol 169 (3) ◽  
pp. 329-337 ◽  
Author(s):  
M A E M Wagenmakers ◽  
H D Boogaarts ◽  
S H P P Roerink ◽  
H J L M Timmers ◽  
N M M L Stikkelbroeck ◽  
...  
Keyword(s):  
Treatment Option ◽  
Cushing’S Disease ◽  
Remission Rate ◽  
Pituitary Surgery ◽  
Primary Treatment ◽  
Endoscopic Technique ◽  
Cushing's Disease ◽  
Recurrence Rates ◽  
Transsphenoidal Pituitary Surgery

ContextAlthough the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now.ObjectiveTo gain insight into the role of endoscopic TS as a primary treatment option for CD, especially in patients with magnetic resonance imaging (MRI)-negative CD and (invasive) macroadenomas.DesignRetrospective cohort study.Patients and methodsThe medical records of 86 patients with CD who underwent endoscopic TS were examined. Data on preoperative and postoperative evaluation, perioperative complications, and follow-up were collected. Remission was defined as disappearance of clinical symptoms with a fasting plasma cortisol level ≤50 nmol/l either basal or after 1 mg dexamethasone.ResultsThe remission rate in different adenoma subclasses varied significantly: 60% in MRI-negative CD (n=20), 83% in microadenomas (n=35), 94% in noninvasive macroadenomas (n=16), and 40% in macroadenomas that invaded the cavernous sinus (n=15). The recurrence rate was 16% after 71±39 months of follow-up (mean±s.d., range 10–165 months).ConclusionsEndoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable with those reported for microscopic TS. Our data suggest that in patients with noninvasive and invasive macroadenomas, the endoscopic technique of TS should be the treatment of choice as remission rates seem to be higher than those reported for microscopic TS, although no comparative study has been performed.

scholarly journals T1 mapping in Cushing's disease: a follow-up study

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Roux Charles ◽  
Nadjia Kachenoura ◽  
Peter Kamenicky ◽  
Elie Mousseaux ◽  
Philippe Chanson ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
T1 Mapping ◽  
Cushing's Disease ◽  
Follow Up Study

Results of external pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease

1991 ◽  
Vol 125 (4) ◽  
pp. 470-474 ◽  
Author(s):  
A. Vicente ◽  
J. Estrada ◽  
C. de la Cuerda ◽  
B. Astigarraga ◽  
M. Marazuela ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
High Efficiency ◽  
Cushing's Disease ◽  
Anterior Pituitary Function ◽  
Low Incidence ◽  
Pituitary Irradiation ◽  
Age Range ◽  
Pituitary Adrenal Axis ◽  
Tsh Deficiency

Abstract. Fourteen adult patients (10 females and 4 males; age range 20-60 years) with persistent Cushing's disease after transsphenoidal microsurgery were treated with pituitary irradiation. Supervoltage multiportal administration was employed at a total dose of 50 Gy (±0.65 sd). The interval between microsurgery and pituitary irradiation was less than 6 months in 6 patients and more than 6 months in 8. The pituitary-adrenal axis was evaluated postsurgically, before irradiation and every 6 months thereafter. The remaining anterior pituitary function was simultaneously tested. Remission rates at 12 months and 24 months after radiotherapy were 61 and 70%, respectively. Two patients developed TSH deficiency and another gonadotropin deficiency during the follow-up after radiation. We conclude that pituitary irradiation is the treatment of choice for persistent Cushing's disease after unsuccessful surgery because of its high efficiency and low incidence of adverse reactions when compared with other forms of treatment.

MEGAVOLTAGE PITUITARY IRRADIATION IN THE MANAGEMENT OF CUSHING'S DISEASE AND NELSON'S SYNDROME: LONG-TERM FOLLOW-UP

1989 ◽  
Vol 31 (3) ◽  
pp. 309-323 ◽  
Author(s):  
T. A. HOWLETT ◽  
P. N. PLOWMAN ◽  
J. A. H. WASS ◽  
L. H. REES ◽  
A. E. JONES ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome ◽  
Long Term Follow Up ◽  
Pituitary Irradiation

Long Term Follow-up of Cushing's Disease Treated with Reserpine and Pituitary Irradiation Followed by Subtotal Adrenalectomy.

1994 ◽  
Vol 172 (2) ◽  
pp. 97-109
Author(s):  
MASANORI MURAYAMA ◽  
KEIGO YASUDA ◽  
YOSHIAKI MINAMORI ◽  
LEILANI B. MERCADO-ASIS ◽  
NORIYOSHI YAMAKITA ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Subtotal Adrenalectomy ◽  
Long Term Follow Up ◽  
Pituitary Irradiation
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