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.

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.

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

LONG-TERM FOLLOW-UP OF LOW-DOSE EXTERNAL PITUITARY IRRADIATION FOR CUSHING'S DISEASE

1990 ◽  
Vol 33 (4) ◽  
pp. 445-455 ◽  
Author(s):  
M. D. LITTLEY ◽  
S. M. SHALET ◽  
C. G. BEARDWELL ◽  
S. R. AHMED ◽  
M. L. SUTTON
Keyword(s):  
Cushing’S Disease ◽  
Low Dose ◽  
Cushing's Disease ◽  
Long Term Follow Up ◽  
Pituitary Irradiation

scholarly journals Long-term anterior pituitary function in patients with paediatric Cushing’s disease treated with pituitary radiotherapy

2007 ◽  
Vol 156 (4) ◽  
pp. 477-482 ◽  
Author(s):  
L F Chan ◽  
H L Storr ◽  
P N Plowman ◽  
L A Perry ◽  
G M Besser ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Anterior Pituitary ◽  
Serum Cortisol ◽  
Pituitary Function ◽  
Cushing's Disease ◽  
Serum Prolactin ◽  
Second Line ◽  
Anterior Pituitary Function

Background/objective: Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing’s disease (CD). Although the short-term effects of pituitary RT are well documented, there are less data on possible long-term sequelae. We report the long-term anterior pituitary function in a cohort of paediatric CD patients treated with pituitary RT. Patients and methods: Between 1983 and 2006, 12 paediatric CD patients (10 males and 2 females) of mean age 11.4 years at diagnosis (range 6.4–17.4) underwent second-line pituitary RT (45 Gy in 25 fractions), following unsuccessful transsphenoidal surgery. Out of 12, 11 patients were cured by RT (cure interval 0.13–2.86 years) defined by mean serum cortisol of <150 nmol/l on 5-point day curve and midnight sleeping cortisol of <50 nmol/l. Long-term data are available for six male patients, who received RT at the age of 7.0–17.6 years. The mean follow-up from the completion of RT was 10.5 years (6.6–16.5). Results: At a mean of 1.0 year (0.11–2.54) following RT, GH deficiency (peak GH <1–17.9 mU/l) was present in five out of six patients. On retesting at a mean of 9.3 years (7.6–11.3) after RT, three out of four patients were GH sufficient (peak GH 19.2–50.4 mU/l). Other anterior pituitary functions including serum prolactin in five out of six patients were normal on follow-up. All the six patients had testicular volumes of 20–25 ml at the age of 14.5–28.5 years. Conclusion: This series of patients illustrates the absence of serious long-term pituitary deficiency after RT and emphasises the importance of continued surveillance.

The recovery of the hypothalamo-pituitary-ad renal axis after transsphenoidal operation in three patients with Cushing's disease. The effect of prior external pituitary irradiation

1981 ◽  
Vol 98 (4) ◽  
pp. 580-585 ◽  
Author(s):  
Steven W.J. Lamberts ◽  
Jan G. M. Klijn ◽  
Frank H. de Jong ◽  
Jan C. Birkenhäger
Keyword(s):  
Growth Hormone ◽  
Cushing’S Disease ◽  
Plasma Cortisol ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Cushing's Disease ◽  
Plasma Acth ◽  
Basal Plasma ◽  
Pituitary Irradiation ◽  
Pituitary Adrenal Axis

Abstract. The recovery of the hypothalamo-pituitary-adrenal axis after selective transsphenoidal adenomectomy was studied in 3 patients with Cushing's disease by measuring basal plasma ACTH and cortisol concentrations, cortisol secretion rate, the diurnal rhythm of cortisol, and the reaction of cortisol to lysine vasopressin (LVP), of compound S to metyrapone and of cortisol and growth hormone to an insulin-induced hypoglycaemia. The third patient had been treated previously by external pituitary irradiation. In 2 patients basal plasma ACTH levels returned within normal values before plasma cortisol, but no supra-physiological plasma concentrations of ACTH were seen as has been observed after withdrawal of exogenous glucocorticoids. With regard to the different stimulation tests: at first the normal reaction of plasma cortisol to LVP returned after 3 months, at the same time as the restoration of growth hormone secretion in response to hypoglycaemia. A normalization of the reaction to metyrapone was seen thereafter while finally the reaction of cortisol to an insulin-induced hypoglycaemia and the diurnal rhythm of plasma cortisol returned 15 to 18 months after operation in the first patient and after 12 months in the second patient. Selective adenomectomy had also been carried out in the third patient, as evidenced by normal TSH, LH and FSH secretion. Hypocortisolism, and a deficient ACTH and growth hormone secretion in response to the stimuli mentioned, however, did not normalize up till 22 months after operation. The restoration of the hypothalamo-pituitary-adrenal axis after selective pituitary adenomectomy in Cushing's disease was prevented in this patient by prior external pituitary irradiation.

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.

Long term follow-up of Cushing's disease treated with reserpine and pituitary irradiation.

1992 ◽  
Vol 75 (3) ◽  
pp. 935-942 ◽  
Author(s):  
M Murayama ◽  
K Yasuda ◽  
Y Minamori ◽  
L B Mercado-Asis ◽  
N Yamakita ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Long Term Follow Up ◽  
Pituitary Irradiation
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