James P Caruso1, Mohana Rao Patibandla1, Zhiyuan Xu1, Mary Lee Vance2, Jason P Sheehan1,3. 1. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia. 2. Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia. 3. Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia.
Abstract
BACKGROUND: Nelson's syndrome may be a devastating complication for patients with Cushing's disease who underwent a bilateral adrenalectomy. Previous studies have demonstrated that stereotactic radiosurgery (SRS) can be used to treat patients with Nelson's syndrome. OBJECTIVE: To report a retrospective study of patients with Nelson's syndrome treated with Gamma Knife radiosurgery to evaluate the effect of SRS on endocrine remission and tumor control. METHODS: Twenty-seven patients with Nelson's syndrome treated with Gamma Knife radiosurgery after bilateral adrenalectomy were included in this study. After radiosurgery, patients were followed with serial adrenocorticotropic hormone (ACTH) levels and MRI sequences to assess for endocrine remission and tumor control. Cox proportional hazards regression analysis was used to evaluate the relationship between the time to remission and potential prognostic factors. RESULTS: In 21 patients with elevated ACTH prior to SRS and endocrine follow-up data, 14 (67%) had decreased or stable ACTH levels, and 7 achieved a normal ACTH level at a median of 115 mo (range 7-272) post-SRS. Tumor volume was stable or reduced after SRS in 92.5% of patients (25/27) with radiological follow-up. Time to remission was not significantly associated with the ACTH prior to SRS (P = .252) or with the margin dose (P = .3). However, a shorter duration between the patient's immediate prior transsphenoidal resection and SRS was significantly associated with a shorter time to remission (P = .045). CONCLUSION: This retrospective analysis suggests that SRS is an effective means of achieving endocrine remission and tumor control in patients with Nelson's syndrome.
BACKGROUND:Nelson's syndrome may be a devastating complication for patients with Cushing's disease who underwent a bilateral adrenalectomy. Previous studies have demonstrated that stereotactic radiosurgery (SRS) can be used to treat patients with Nelson's syndrome. OBJECTIVE: To report a retrospective study of patients with Nelson's syndrome treated with Gamma Knife radiosurgery to evaluate the effect of SRS on endocrine remission and tumor control. METHODS: Twenty-seven patients with Nelson's syndrome treated with Gamma Knife radiosurgery after bilateral adrenalectomy were included in this study. After radiosurgery, patients were followed with serial adrenocorticotropic hormone (ACTH) levels and MRI sequences to assess for endocrine remission and tumor control. Cox proportional hazards regression analysis was used to evaluate the relationship between the time to remission and potential prognostic factors. RESULTS: In 21 patients with elevated ACTH prior to SRS and endocrine follow-up data, 14 (67%) had decreased or stable ACTH levels, and 7 achieved a normal ACTH level at a median of 115 mo (range 7-272) post-SRS. Tumor volume was stable or reduced after SRS in 92.5% of patients (25/27) with radiological follow-up. Time to remission was not significantly associated with the ACTH prior to SRS (P = .252) or with the margin dose (P = .3). However, a shorter duration between the patient's immediate prior transsphenoidal resection and SRS was significantly associated with a shorter time to remission (P = .045). CONCLUSION: This retrospective analysis suggests that SRS is an effective means of achieving endocrine remission and tumor control in patients with Nelson's syndrome.
Authors: Martin Reincke; Adriana Albani; Guillaume Assie; Irina Bancos; Thierry Brue; Michael Buchfelder; Olivier Chabre; Filippo Ceccato; Andrea Daniele; Mario Detomas; Guido Di Dalmazi; Atanaska Elenkova; James Findling; Ashley B Grossman; Celso E Gomez-Sanchez; Anthony P Heaney; Juergen Honegger; Niki Karavitaki; Andre Lacroix; Edward R Laws; Marco Losa; Masanori Murakami; John Newell-Price; Francesca Pecori Giraldi; Luis G Pérez-Rivas; Rosario Pivonello; William E Rainey; Silviu Sbiera; Jochen Schopohl; Constantine A Stratakis; Marily Theodoropoulou; Elisabeth F C van Rossum; Elena Valassi; Sabina Zacharieva; German Rubinstein; Katrin Ritzel Journal: Eur J Endocrinol Date: 2021-03 Impact factor: 6.664
Authors: M Losa; M Detomas; M Bailo; L R Barzaghi; L Albano; M Piloni; A Pagnano; E Pedone; P Mortini Journal: J Endocrinol Invest Date: 2021-02-20 Impact factor: 4.256