title: [Retrospective analysis to evaluate efficacy and safety of stereotactic radiosurgery in Cushing's disease: 24 cases and a review].
abstract: BACKGROUND
  In the past few years, stereotactic radiosurgery (SRS) has been suggested as a good alternative, second line therapy for the management of patients with ACTH-secreting pituitary adenomas. A retrospective study has been conducted in order to evaluate the efficacy and safety of this treatment in these patients.
  
  
  METHODS
  Data were collected on all patients treated with SRS for an ACTH-secreting pituitary adenoma between 1996 and 2008, and with at least one year of follow-up. An analysis was carried out by analysing the return to normal of the hormone levels and clinical improvement rates (including Cushing signs, arterial hypertension), as well as adverse effects, and disease relapse. A return to normal of the 24 hour urinary free cortisol (24-UFC) levels (<100 μg/day) without any ACTH-secretion suppressor drug treatment, was considered as cure or improvement.
  
  
  RESULTS
  A total of 30 patients were treated with SRS, of which 24 were included in the analysis. They all had high 24-UFC levels before the treatment. Cure was achieved in 12 (50%) in a mean of 28 months, and in other 3 patients 24-UFC levels returned to normal with treatment with ketoconazole after the SRS. Cushing signs improved in all cases, as well as arterial hypertension in 13 out of 14 cases. There were relapses after cure consolidation. As far as adverse effects, it should be mentioned that there were 9 cases of new pituitary hormonal dysfunction (the most frequent being hypothyroidism), one radionecrosis, and one case of visual field defect impairment. Radiation-related neoplasm was not detected in any of the cases.
  
  
  CONCLUSIONS
  SRS is an effective treatment for those patients with ACTH-secreting pituitary adenoma in whom surgery has failed, or in those that are not good candidates for it. It showed good rates of hormone levels returning to normal, as well as clinical disease control and a low level of adverse effects.
authors.affiliation: Servicio de Neurocirugía, Hospital Juan Ramón Jimenez, Huelva, España. Electronic address: miguel_ars1982@hotmail.com.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Roldán Serrano
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: Angel
authors.initials: A
authors.lastname: Horcajadas Almansa
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario San Cecilio, Granada, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Torres Vela
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sánchez Corral
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Moliz Molina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adenomas hipofisarios; Cushing's disease; Enfermedad de Cushing; Pituitary adenoma; Pituitary tumour; Radiación; Radiation; Radiocirugía; Radiosurgery; Tumor hipofisario