Gamma-knife surgery for secreting pituitary adenomas.
We report our preliminary results concerning 25 patients with secreting pituitary adenomas treated with stereotactic radiosurgery after partial transsphenoidal surgery and followed over a 6-36 month-period. Among the 15 acromegalic patients, a decrease of 65% in mean GH levels was achieved after 6 months and of 77% at 12 months after radiosurgery. Presently, only 3 patients (20%) are considered as in remission (mean GH and IGF1 level into the normal range). A decrease of 46% and 64% was observed at 6 and 12 months after radiosurgery in 4 patients with prolactinomas although no normalization of PRL levels occurred. Presently, 3/4 patients have individual PRL level slightly above the normal range. A normalization of Urinary Free Cortisol (UFC) was noticed in 4/6 (66%) patients with Cushing's disease within 6-12 months. No pituitary deficiency was noticed in this series with the exception of 4/25 patients (16%) who received subtotal or total pituitary irradiation for post-operative remnants of secreting adenomas poorly defined on MRI. One woman, who had undergone previously a conventional irradiation and presenting with a cavernous sinus adenoma reaching the optic nerve, developed an optic neuropathy. A second woman, with a cavernous sinus remnant, presented a cranial nerve palsy (VI) after the irradiation. We can conclude that radiosurgery using the Cobalt-60 Gamma-unit is, at least, as effective as conventional radiotherapy in the control of pituitary hormone hypersecretion from postoperative adenomas remnants with less adverse effects.
Morange-Ramos
I
I
Department of Endocrinology, Hopital de la Timone, Marseilles, France.
Regis
J
J
Dufour
H
H
Andrieu
J M
JM
Grisoli
F
F
Jaquet
P
P
Peragut
J C
JC
D000172:Acromegaly / Q000097:blood / Q000601:surgery; D000236:Adenoma / Q000097:blood / Q000601:surgery* / Q000652:urine; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000601:surgery* / Q000652:urine; D015175:Prolactinoma / Q000097:blood / Q000601:surgery; D016634:Radiosurgery / Q000009:adverse effects / Q000592:standards; D012074:Remission Induction; D013100:Sphenoid Bone / Q000601:surgery; D013238:Stereotaxic Techniques; D016896:Treatment Outcome