title: Long-term results of stereotactic radiosurgery to the pituitary gland in Cushing's disease.
abstract: Gamma radiation from 60Co delivered with stereotactic technique was given to the pituitary gland in 35 patients, aged 18-65 years, with Cushing's disease. The doses were 70-100 Gy in each single irradiation. The size of the sella turcica was normal in the majority of the patients. The observation time was 3-9 years in 29 patients. Out of them, 14 (48%) obtained clinical remission and normal urinary cortisol after one irradiation. Eight achieved remission after two to four irradiations. In total, 22 out of 29 patients (76%) obtained remission. In 12 of them remission was obtained in 1 year and in another 10 within 3 years. No recurrences were observed. Improvement was seen in 2 patients after one and three irradiations. Bilateral adrenalectomy was performed in 5 patients owing to unsatisfactory effect of irradiation. Pituitary insufficiency with gonadotropin, thyrotropin or corticotropin failure was demonstrated in 12 of 22 patients in remission. This occurred 4 months to 7 years after the first irradiation. Another 6 patients were followed less than 3 years after the first irradiation. Two obtained remission after the first treatment, whereas the other 4 improved. Stereotactic pituitary irradiation is suggested as a non-invasive therapeutic alternative in Cushing's disease for example in patients with considerable surgical risk or as a supplement to pituitary microsurgery.
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003037:Cobalt Radioisotopes / Q000627:therapeutic use*; D003480:Cushing Syndrome / Q000378:metabolism / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000097:blood; D006801:Humans; D008297:Male; D010900:Pituitary Diseases / Q000209:etiology; D010910:Pituitary Irradiation / Q000009:adverse effects / Q000379:methods*; D013238:Stereotaxic Techniques
chemical_list: D003037:Cobalt Radioisotopes; D006728:Hormones