Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing's disease

Degerblad, Marie; Rähn, T.; Bergstrand, G.; Thorén, Marja

doi:10.1530/acta.0.1120310

Cited by 138 publications

(63 citation statements)

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“…Treatment was administered using an early version of the Gamma Knife. 7 Of the 29 patients who were followed up for longer than 3 years, disease remission was achieved in 14 (48%) after a single maximal dose of radiosurgery, which ranged between 70 and 100 Gy. An additional eight patients experienced remission of their disease after undergoing between one and three radiosurgical procedures, for a total of 22 patients (76%) in biochemical remission.…”

Section: Results Of Srsmentioning

confidence: 97%

“…Early results of radiosurgical treatment of ACTH-producing adenomas were encouraging, even though until approximately 1980 neurosurgeons were limited to using pneumoencephalography for outlining the lesions to be treated. Degerblad, et al, 7 reported their results in 35 patients with Cushing disease who were treated between 1975 and 1982 at Karolinska Hospital by using pneumoencephalography-based radiosurgery. Treatment was administered using an early version of the Gamma Knife.…”

Section: Results Of Srsmentioning

confidence: 99%

“…This maximal dose of 40 Gy likely represents a dose of 20 Gy to the tumor margin, which is substantially less than that reported by the groups from Sweden. 7,18 Nevertheless, it is probable that the good outcomes attained by Pollock, et al, 40 were related to significantly better targeting capabilities afforded by CT and MR imaging than existed with pneumoencephalography. Also in contrast to the studies discussed previously, this group rigorously reported incidences of morbidity.…”

Section: Neurosurg Focus / Volume 16 / April 2004mentioning

confidence: 99%

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Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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The most common cause of Cushing syndrome is Cushing disease, in which hypercortisolism is produced by a functional adrenocorticotropic hormone–producing adenoma of the anterior pituitary gland. The common therapies available include microsurgical resection, conventional fractionated radiotherapy, and stereotactic radiosurgery (SRS). In this article the authors review the indications, results, and complications associated with SRS in the treatment of Cushing disease. In as many as 90% of patients SRS results in disease remission, which is defined as a normal 24-hour urinary free cortisol level and a normal or subnormal morning serum cortisol level. Although in most patients who are subsequently cured a marked decrease in the serum cortisol level is demonstrated within 3 months after treatment, a biochemical cure may be delayed up to 3 years in some cases. Complications following SRS for pituitary adenomas are uncommon, particularly in patients with microadenomas, which are most commonly seen in Cushing disease. The most common complication is hypopituitarism, which occurs in up to 50% of patients with a mean latency period of 5 years. Radiation-induced optic neuropathy has been reported in less than 2% of cases and induction of a secondary neoplasm in less than 1% of cases. For patients with Cushing disease, the rate of endocrinological cure following SRS appears to be similar to that attained using microsurgical resection. In contrast to surgery, SRS has the benefit of being noninvasive and associated with a very low incidence of diabetes insipidus, although hypopituitarism may be more common with SRS. With continued follow-up patient reviews and additional experience with SRS, it may become possible to make more definitive statements regarding SRS as the initial treatment for patients with Cushing disease.

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Section: Results Of Srsmentioning

confidence: 97%

Section: Results Of Srsmentioning

confidence: 99%

Section: Neurosurg Focus / Volume 16 / April 2004mentioning

confidence: 99%

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Stereotactic radiosurgery for Cushing disease

Hentschel¹,

McCutcheon²

2004

FOC

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“…GKS seems to be most effective in Nelson's syndrome when it is administered soon after TBA (82) and when the anatomical target is clear and discrete (less likely with prior surgery, which may render the tumour border indistinct (78,81)). Potential adverse effects of GKS include panhypopituitarism (up to at least 7 years post surgery (84)) and cranial nerve palsies. GKS is therefore not suitable for tumours adjacent to the optic apparatus and those invading the cavernous sinus.…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Nelson's syndrome

Barber

Adams²,

Ansorge³

et al. 2010

European Journal of Endocrinology

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Nelson's syndrome is a potentially life-threatening condition that does not infrequently develop following total bilateral adrenalectomy (TBA) for the treatment of Cushing's disease. In this review article, we discuss some controversial aspects of Nelson's syndrome including diagnosis, predictive factors, aetiology, pathology and management based on data from the existing literature and the experience of our own tertiary centre. Definitive diagnostic criteria for Nelson's syndrome are lacking. We argue in favour of a new set of criteria. We propose that Nelson's syndrome should be diagnosed in any patient with prior TBA for the treatment of Cushing's disease and with at least one of the following criteria: i) an expanding pituitary mass lesion compared with pre-TBA images; ii) an elevated 0800 h plasma level of ACTH (O500 ng/l) in addition to progressive elevations of ACTH (a rise of O30%) on at least three consecutive occasions. Regarding predictive factors for the development of Nelson's syndrome post TBA, current evidence favours the presence of residual pituitary tumour on magnetic resonance imaging (MRI) post transsphenoidal surgery (TSS); an aggressive subtype of corticotrophinoma (based on MRI growth rapidity and histology of TSS samples); lack of prophylactic neoadjuvant pituitary radiotherapy at the time of TBA and a rapid rise of ACTH levels in year 1 post TBA. Finally, more studies are needed to assess the efficacy of therapeutic strategies in Nelson's syndrome, including the alkylating agent, temozolomide, which holds promise as a novel and effective therapeutic agent in the treatment of associated aggressive corticotroph tumours. It is timely to review these controversies and to suggest guidelines for future audit.

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“…Other authors have also reported this rapid remission. 17,35,42 Conventional fractionated radiotherapy also appears effective after failed transsphenoidal surgery. Savage and colleagues 39 reported biochemical remission in 82% after a median period of 8 years.…”

Section: Comparison Of Gks and Conventional Radiotherapymentioning

confidence: 99%

Stereotactic radiosurgery for hypersecreting pituitary tumors: part of a multimodality approach

Jane¹,

Vance²,

Woodburn³

et al. 2003

FOC

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Object Surgical and medical therapies successfully achieve biochemical remission in the majority of patients with secretory pituitary adenomas. Nevertheless, continued hypersecretion after first-line therapy occurs and requires adjunctive therapy to prevent morbidity and premature mortality. For patients in whom medical and surgical therapy have failed, gamma knife surgery (GKS) is performed with the goal of controlling tumor growth and excess growth hormone (GH) production. The authors report their experience with GKS in patients in whom surgical and medical therapies failed. Methods The neuroendocrine service at the University of Virginia has treated 220 patients with secretory adenomas. The authors evaluated the biochemical results in patients with acromegaly followed for greater than 18 months (64 patients) as well as those with Cushing disease (45 patients), Nelson syndrome (14 patients with adequate follow up [27 overall]), and prolactinomas (19 patients) followed for at least 12 months posttreatment. Biochemical remission occurred in 36% of patients with GH-secreting adenomas, 73% of those with Cushing disease, 14% of those with Nelson syndrome, and 11% of those harboring prolactinomas. Recurrence after biochemical remission was documented in four patients with Cushing disease. New hormonal deficits have occurred in 28% of patients with acromegaly, 31% with Cushing disease, 36% with Nelson syndrome, and 21% with prolactinomas. Minor visual deterioration developed in one patient with Cushing disease. Conclusions Gamma knife surgery offers an important treatment modality in patients with secretory adenomas refractory to surgical and medical interventions.

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Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing's disease

Cited by 138 publications

References 0 publications

Stereotactic radiosurgery for Cushing disease

Stereotactic radiosurgery for Cushing disease

Nelson's syndrome

Stereotactic radiosurgery for hypersecreting pituitary tumors: part of a multimodality approach

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