Pituitary Function Following Megavoltage Therapy for Cushing's Disease: Long Term Follow Up

Sharpe, G. F.; Kendall‐Taylor, P.; Prescott, R. W. G.; Ross, W. M.; Davison, Cathy Bruner; Watson, M. J.; Cook, David B.

doi:10.1111/j.1365-2265.1985.tb01078.x

Cited by 29 publications

(15 citation statements)

References 13 publications

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“…In contrast, multiple studies have reported that the 'majority' of patients who have undergone conventional fractionated EBT later present with posttreatment pituitary dysfunction [24,27,34,36]. Our results are slightly higher than other results reported in the literature.…”

Section: Discussioncontrasting

confidence: 57%

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Devin

Allen

Cmelak

et al. 2004

Stereotact Funct Neurosurg

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We identified 35 patients who had undergone stereotactic radiosurgery (SRS) for their biochemically proven Cushing’s disease in order to assess the efficacy of SRS with regard to control of hypercortisolism, improvement of clinical features and prevention of tumor progression, and subsequent incidence of hypopituitarism. Seventeen (49%) patients achieved control of their cortisol levels following SRS; the mean time to normalization was 7.5 months (range: 1–33). Four (19%) patients experienced recurrent hypercortisolism at a mean time of 35.5 months following therapy (range: 17–64). Control of tumor progression was achieved in 91% patients. Fourteen (40%) patients demonstrated a new pituitary deficiency following SRS. Our results suggest that cortisol levels are normalized more efficiently and with a lower recurrence rate with SRS than with conventional fractionated external beam radiotherapy (EBT). We have confirmed the near 100% tumor control rate reported with SRS. The percentage of patients developing pituitary insufficiency following SRS is less than that of patients having undergone EBT; however, deficits occurred up to 10 years posttreatment. We advocate the use of SRS as the primary therapeutic modality in those patients who are poor surgical candidates, or as the adjunct treatment to microsurgery in eliminating residual tumor cells or disease that is not easily amenable to resection.

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Section: Discussioncontrasting

confidence: 57%

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Devin

Allen

Cmelak

et al. 2004

Stereotact Funct Neurosurg

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“…Proximity to the optic chiasm is a major concern, as at least 2-5 mm distance from the tumor is required to avoid excessive radiation (no greater than 6-14 Gy). Containment of hypercortisolism occurs in 50-83% of adults [61,62] and up to 80% of children [63] treated with conventional external beam radiotherapy (CRT). Tumors with maximal diameter >3.5 mm are better approached by conventional large-field fractionated radiotherapy.…”

Section: Pituitary Radiationmentioning

confidence: 99%

Cushing’s disease

2006

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Cushing's disease, i.e., pituitary ACTH-secreting adenoma causing excess glucocorticoid secretion, is a rare disease with significant mortality and morbidity. Timely diagnosis and appropriate treatment can alter the course of the disease and are therefore mandatory. First step of the diagnostic work-up is the endogenous glucocorticoid excess by measurement of urinary free cortisol, cortisol circadian rhythmicity or suppression by low doses of dexamethasone. In patients with equivocal results, second line tests, such as the dexamethasone-suppressed CRH test and desmopressin stimulation, usually enable the diagnosis to be confirmed. Measurement of plasma ACTH then allows the distinction between ACTH-dependent (e.g., pituitary or extrapituitary neuroendocrine tumors) and ACTH-independent causes (e.g., adrenal tumors). The last step in the diagnostic algorithm is often the most fraught with problems as the distinction between Cushing's disease and ectopic ACTH secretion relies on judicious interpretation of several diagnostic procedures. Positive responses to stimulation with CRH and inhibition by high doses of dexamethasone, if concurrent, enable a pituitary origin to be established whereas conflicting results call for inferior petrosal sinus sampling, the latter to be performed in experienced centres only. Visualisation of the tumor at pituitary imaging is helpful but not required for the diagnosis, as microadenomas often remain undectected by MRI and/or CT scan and, on the other hand, visualisation of a non-secreting incidentaloma may be misleading. Surgical removal of the pituitary tumor is the optimal treatment choice and should be attempted in every patient. Surgical failures as well as relapses can be treated by radiotherapy, medical therapy or, if necessary, bilateral adrenalectomy. Finally, patients cured of Cushing's disease require long-term monitoring given the risk of relapse and clinical burden of associated ailments.

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“…Além disso, podem ser necessários até 2 anos ou mais para que se obtenha um efeito terapêutico pleno (5,(13)(14)(15)(16). Um outro importante inconveniente da radioterapia é o freqüente surgimento de hipopituitarismo (1,2).…”

Section: Radioterapiaunclassified

“…Um outro importante inconveniente da radioterapia é o freqüente surgimento de hipopituitarismo (1,2). Entre 139 pacientes com doença de Cushing, observaram-se as seguintes deficiências hormonais: GH em 86%, ACTH em 20%, LH/FSH em 18% e TSH em 6% (13)(14)(15)(16). A principal indicação da radioterapia é para pacientes com hipercortisolismo persistente ou recidivante após a TSA (2,5); nesses casos, consegue-se uma taxa de remissão de 55 a 83%, geralmente dentro dos primeiros dois anos após a radioterapia (17,18).…”

Section: Radioterapiaunclassified

Tratamento medicamentoso dos tumores hipofisários. parte II: adenomas secretores de ACTH, TSH e adenomas clinicamente não-funcionantes

Vilar

Naves

Freitas

et al. 2000

Arq Bras Endocrinol Metab

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This article reviews the potencial role of medical treatment for both ACTH and TSH secreting pituitary adenomas, as well as for clinically non-functionning pituitary adenomas (CNFPA). Metyrapone, mitotane and ketoconazole (preferable for causing less side-effects) are the most effective drugs for the control of hypercortisolism but none of them surpasses the efficacy of transsphenoidal surgery (TSA). Drug therapy in Cushing's disease is therefore better indicated for patients waiting for the full effect of radiotherapy or, as an alternative to radiotherapy, for cases of TSA failure as well as patients that refuse or have clinical limitations to surgery. Other potential indications for medical treatment in Cushing's disease include elderly patients with microadenomas or small macroadenomas, as well as cases associated to an empty sella. Concerning TSH-secreting adenomas, somatostatin analogues (SRIFa) lead to normalization of thyroid hormones in up to 95% of treated patients. Therefore they may represent an useful tool for long-term treatment of such rare tumors in case of surgery failure or as primary therapy for selected cases. Occasionaly, dopamine agonists (DA), especially cabergoline, may also be efficacious in normalizing hormone levels. In contrast, DA and SRIFa rarely induce significant tumor shrinkage in patients with CNFPA. Thus, these drugs should be considered particularly for patients who are poor candidates for surgery or in whom surgery and radiotherapy have failed to control the disease. (Arq Bras Endocrinol Metab 2000;44/6: 455-470)

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Pituitary Function Following Megavoltage Therapy for Cushing's Disease: Long Term Follow Up

Cited by 29 publications

References 13 publications

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

The Efficacy of Linear Accelerator Radiosurgery in the Management of Patients with Cushing’s Disease

Cushing’s disease

Tratamento medicamentoso dos tumores hipofisários. parte II: adenomas secretores de ACTH, TSH e adenomas clinicamente não-funcionantes

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