title: Long term follow-up of patients with Cushing's disease treated by interstitial irradiation.
abstract: The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3-26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred. Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T4 replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years. Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectomy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.
mesh_terms: D000293:Adolescent; D000328:Adult; D001918:Brachytherapy / Q000009:adverse effects*; D002648:Child; D003480:Cushing Syndrome / Q000150:complications / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006050:Gold Radioisotopes / Q000008:administration & dosage; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: D006050:Gold Radioisotopes; D015021:Yttrium Radioisotopes