Lack of Radiation Optic Neuropathy in 72 Patients Treated for Pituitary Adenoma

Bergh, A. Van den; Dullaart, Rpf; Vliet, AM van der; Szabo, BG; Weeme, CA ter; Pott, Jwr

doi:10.1097/00041327-200409000-00003

Cited by 32 publications

(14 citation statements)

References 49 publications

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“…Secondly, hypercortisolism could be involved in the late onset, as well as in the higher prevalence, of this complication in patients with Cushing disease. Indeed, in a large series of patients with clinically non-functioning pituitary tumor who had undergone radiation therapy, no patient had radiation-induced optic neuropathy (17). Moreover, on reviewing the literature on radiation-treated nonfunctioning pituitary tumors, the same authors discovered that the incidence of radiation-induced optic neuropathy in these patients was 0.53% (17).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in a large series of patients with clinically non-functioning pituitary tumor who had undergone radiation therapy, no patient had radiation-induced optic neuropathy (17). Moreover, on reviewing the literature on radiation-treated nonfunctioning pituitary tumors, the same authors discovered that the incidence of radiation-induced optic neuropathy in these patients was 0.53% (17). Finally, the clinical course observed in our patient confirms that HBO therapy could be an effective, non-invasive modality for the treatment of radiation-induced optic neuropathy, and that prompt treatment and a proper technique are critical for the management of this severe complication.…”

Section: Discussionmentioning

confidence: 99%

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Partial visual recovery from radiation-induced optic neuropathy after hyperbaric oxygen therapy in a patient with Cushing disease

Boschetti¹,

Lucchi

Giusti³

et al. 2006

eur j endocrinol

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Here we describe the case of a 41-year-old woman with a history of Cushing disease who had previously undergone unsuccessful neurosurgery, followed by stereotactic radiosurgery. More than 4 years after this treatment, she presented severe visual impairment, which started in the left eye and was documented by neuro-ophthalmic evaluation. Radiological assessment by contrast-enhanced magnetic resonance (MR) imaging initially suggested the diagnosis of glioma of the optic nerve and the patient started corticosteroid treatment (first with prednisone, 80 mg/day, followed by dexamethasone, 8 mg/day). Despite the therapy, vision in the left eye rapidly worsened until light was no longer perceptible; similar symptoms and signs also developed in the right eye, evolving to complete temporal hemianopsia. The clinical evidence was confirmed by the rapid progression of the MR picture, which showed homogeneous enhancement of the chiasm and optic nerves. On the basis of these findings, the original diagnosis of glioma was excluded, and radiation-induced optic neuropathy was diagnosed. As corticosteroids had proved inefficacious, hyperbaric oxygen (HBO) therapy was promptly instituted and vision steadily started to improve. This improvement was documented and confirmed by the progressive recovery of the visual field in the right eye and the changes in the sequential follow-up MR scanning. Optic neuropathy is an infrequent but dramatic complication of radiation therapy. Symptoms develop, on average, 12 months after treatment, and the onset may be acute and characterized by the progressive loss of vision in one or both eyes. HBO has already been used to treat this complication, but its efficacy is still controversial. Here, in addition to describing this particular case, which presented a significantly delayed radiation injury of the optic pathways, we provide a brief literature review and discuss some important points. 154 813-818 European Journal of Endocrinology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Partial visual recovery from radiation-induced optic neuropathy after hyperbaric oxygen therapy in a patient with Cushing disease

Boschetti¹,

Lucchi

Giusti³

et al. 2006

eur j endocrinol

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“…In our patient radiation had a remarkable effect on tumour size and there was a 60% fall in GH levels to 75 mU/l within 3 months and to 4.5 mU/l by 18 months, but still with no pulsatility and no suppression during OGTT. Although the risk of future deterioration of the visual capacity in adults after radiotherapy has been reported to be low (26), regular ophthalmologic examination will be performed as will regular tests of pituitary function.…”

Section: Discussionmentioning

confidence: 99%

Pegvisomant therapy in pituitary gigantism: successful treatment in a 12-year-old girl

Rix¹,

Laurberg²,

Hoejberg³

et al. 2005

eur j endocrinol

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Objective: The use of a growth hormone (GH) receptor antagonist, pegvisomant has shown great promise in adults with acromegaly, but experience in paediatric patients is lacking. We aimed to describe the results of pegvisomant therapy in a 12-year-old girl with an aggressive GH-secreting pituitary tumour. Design: To evaluate the ability of pegvisomant therapy to control the effects of peripheral GH excess in a case of pituitary gigantism. Methods: Pegvisomant was introduced at 10 mg/day, given subcutaneously, and gradually increased to 20 mg/day until serum IGF-I was normal for age. Results: A large pituitary adenoma with suprasellar extension was diagnosed in a 12-year-old girl with progressive tall stature (178 cm), GH hypersecretion without suppression during oral glucose loading (nadir serum GH, 90 mU/l), high serum IGF-I and serum prolactin levels. Surgical extirpation was not possible because tumour tissue was fibrous and adherent to the optical nerves. Histological examination showed a mixed GH-and prolactin-secreting adenoma with lymphocytic infiltration of B and T cells. Treatment with a dopamine agonist, cabergoline, normalized serum prolactin, but GH secretion was resistant to both somatostatin analogue, octreotide and cabergoline. Radiation followed by pegvisomant therapy titrated up in dose to 20 mg/day led to a marked reduction in GH secretion and normalization of IGF-I, and to growth arrest and improvement of well-being. Conclusions: We suggest that treatment in pituitary gigantism with pegvisomant is safe and may normalize IGF-I levels and effectively stop growing.

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“…33 When RION has occurred after treatment with lower cumulative dosages, the toxic effects of the radiation in some cases were probably potentiated by the concurrent administration of chemotherapeutic drugs, or pre-existing factors such as optic nerve compression that increased the patient's susceptibility. 34 However, the risk of RION appears to increase with increasing doses over 50 Gy which is a similar sensitivity to radiation as the spinal cord. In a retrospective review of 219 patients receiving radiotherapy for para-nasal sinus and nasal cavity tumours there were no cases of RION when the dose was under 50 Gy.…”

Section: Radiation Dosementioning

confidence: 99%