BACKGROUND: Irradiation of the pituitary is widely considered the most appropriate treatment for patients with Cushing's disease in whom transsphenoidal microsurgery has been unsuccessful. However, there is little information about the long-term efficacy of this treatment. METHODS: We used external pituitary radiation to treat 30 adult patients with persistent or recurrent Cushing's disease after unsuccessful transsphenoidal surgery. The mean (+/-SD) dose of radiation was 50+/-1 Gy. Pituitary and adrenal function was assessed every six months after radiation therapy. Remission was defined as the regression of symptoms and signs of Cushing's syndrome, normal urinary cortisol excretion, and a low plasma cortisol concentration in the morning after the administration of 1 mg of dexamethasone at midnight. RESULTS: Twenty-five patients (83 percent) had remissions during a median follow-up of 42 months (range, 18 to 114). The remissions began 6 to 60 months after radiation therapy, but in most cases (22 patients) remission occurred during the first 2 years. None of the 25 patients had a relapse of Cushing's disease after remission was achieved. There was no relation between the response to radiotherapy and sex, age, urinary cortisol excretion before radiotherapy, the interval between surgery and radiotherapy, whether a pituitary adenoma was found by pathological examination, or tumor size. Seventeen patients had a deficiency of growth hormone after radiation therapy, 10 had a deficiency of gonadotropins, 4 had a deficiency of thyrotropin, and 1 had a deficiency of corticotropin. CONCLUSIONS: Pituitary irradiation is an effective and well-tolerated treatment for patients with Cushing's disease in whom transsphenoidal surgery is unsuccessful.
BACKGROUND: Irradiation of the pituitary is widely considered the most appropriate treatment for patients with Cushing's disease in whom transsphenoidal microsurgery has been unsuccessful. However, there is little information about the long-term efficacy of this treatment. METHODS: We used external pituitary radiation to treat 30 adult patients with persistent or recurrent Cushing's disease after unsuccessful transsphenoidal surgery. The mean (+/-SD) dose of radiation was 50+/-1 Gy. Pituitary and adrenal function was assessed every six months after radiation therapy. Remission was defined as the regression of symptoms and signs of Cushing's syndrome, normal urinary cortisol excretion, and a low plasma cortisol concentration in the morning after the administration of 1 mg of dexamethasone at midnight. RESULTS: Twenty-five patients (83 percent) had remissions during a median follow-up of 42 months (range, 18 to 114). The remissions began 6 to 60 months after radiation therapy, but in most cases (22 patients) remission occurred during the first 2 years. None of the 25 patients had a relapse of Cushing's disease after remission was achieved. There was no relation between the response to radiotherapy and sex, age, urinary cortisol excretion before radiotherapy, the interval between surgery and radiotherapy, whether a pituitary adenoma was found by pathological examination, or tumor size. Seventeen patients had a deficiency of growth hormone after radiation therapy, 10 had a deficiency of gonadotropins, 4 had a deficiency of thyrotropin, and 1 had a deficiency of corticotropin. CONCLUSIONS: Pituitary irradiation is an effective and well-tolerated treatment for patients with Cushing's disease in whom transsphenoidal surgery is unsuccessful.
Authors: Rosa M Cañón Rodríguez; David Ortiz de Urbina; Juan Carlos Viera; César Beltrán; Fernando Puebla; M Isabel García Berrocal; Ana Mañas; Carmen Peraza; Felipe A Calvo Journal: Clin Transl Oncol Date: 2005-11 Impact factor: 3.405
Authors: Troy H Dillard; S Humayun Gultekin; Johnny B Delashaw; Chris G Yedinak; Edward A Neuwelt; Maria Fleseriu Journal: Pituitary Date: 2011-03 Impact factor: 4.107
Authors: R van der Pas; C de Bruin; A M Pereira; J A Romijn; R T Netea-Maier; A R Hermus; P M Zelissen; F H de Jong; A J van der Lely; W W de Herder; S M Webb; S W J Lamberts; L J Hofland; R A Feelders Journal: Pituitary Date: 2013-12 Impact factor: 4.107
Authors: Jay Jagannathan; Adam S Kanter; Claire Olson; Jonathan H Sherman; Edward R Laws; Jason P Sheehan Journal: J Neurooncol Date: 2008-06-21 Impact factor: 4.130
Authors: Elena Valassi; Beverly M K Biller; Brooke Swearingen; Francesca Pecori Giraldi; Marco Losa; Pietro Mortini; Douglas Hayden; Francesco Cavagnini; Anne Klibanski Journal: J Clin Endocrinol Metab Date: 2010-01-15 Impact factor: 5.958