Conventional Pituitary Irradiation in Acromegaly

Abstract

Thirty-one patients who had been treated for acromegaly for 1\p=n-\21 years with conventional pituitary irradiation were re-examined. Immunoreactive growth hormone (GH) was measured in connection with an oral glucose load. Adrenal and gonadal functions were assessed on the basis of plasma cortisol and the urinary excretion of 17-ketogenic steroids, 17-ketosteroids and gonadotrophins. In evaluating the thyroid-pituitary axis the thyrotrophin-relcasing hormone stimulation test (TRH) was used. Initially 30 patients had experienced definite benefit from the treatment but at the time of re-examination 10 still had clinically active disease and required another type of treatment. Normal GH levels (<5 ng/ml/1) were seen in only 12 patients. Skin thickness was normal in 15 out of 30. Thus the remission rate can be evaluated as being 67 % as regards clinical activity, 50 % with regard to skin thickness and 39 % in terms of GH levels.Hypogonadism occurred in 12 patients (39 %) and adrenal and thyroid failure in 5 patients each (16%). The response to TRH was within the normal range in 2 of the hypothyroid patients. In 22 euthyroid patients the mean increment in serum TSH in response to 200 \g=m\g of synthetic TRH was only 5.8 mU/1 which was significantly below the normal mean 12.5 mU/1. Furthermore, in 7 of these patients (32 %) the response was absent or subnormal (<3.0 mU/1). This indicated that the pituitary is Effect on growth hormone and TSH secretion © O © Ö © Ö ci o: q t-. © oo «5 «î >o «) o Cî © <-< © ci i-i CM CO^to q ci o >o io o o © to tô © co © r-, © »O © © ^© I>! CM © r~-OO Ci © i-« CM 272 ^c o CO c© CO t-H CM © q co >o •^© ci r-co n to co to CO CO CM ci q q n © co -^ö r^© CO t-j CM oq CM CO CO OO CÍ CO © cq cm r--co ci CO CO tO OÍ Tjí © © to t-i oq oi w^tri co <f CO to Cl CM CM © CO to CO CM CO to © Ci -i © CO to i-H to^c e i-i © to r-r-CM to t-I -^CO CO g q o^> o n h O CM Tf' CO CO CM © to CM CO 1-, »o co CO >o to CM <* CO to o © © © © CM WJ © r-CM tO CO to^©

Continuous Subcutaneous Pump Infusion of Somatostatin Analogue SMS 201‐995 Versus Subcutaneous Injection Schedule in Acromegalic Patients

“…This is the case particularly for large pituitary adenomas which release G H only, and it has been documented in treatment by hypophysectomy, irradiation as well as dopaminergic agents (Summers et al, 1975;Lamberg et al, 1976;Wass et al, 1977;Quabbe, 1982;Oppizzi et al, 1984). This is the case particularly for large pituitary adenomas which release G H only, and it has been documented in treatment by hypophysectomy, irradiation as well as dopaminergic agents (Summers et al, 1975;Lamberg et al, 1976;Wass et al, 1977;Quabbe, 1982;Oppizzi et al, 1984).…”

“…It has been characteristic of current and previous treatments of acromegaly that initial enthusiasm was followed by realization of a low rate of success. This is the case particularly for large pituitary adenomas which release G H only, and it has been documented in treatment by hypophysectomy, irradiation as well as dopaminergic agents (Summers et al, 1975;Lamberg et al, 1976;Wass et al, 1977;Quabbe, 1982;Oppizzi et al, 1984).…”

Treatment of Acromegaly by External Irradiation

“…More accurate estimation of the effects of radiotherapy only became possible in the late 1960s when GH levels could be estimated. Early reports of remission rate as judged by clinical activity are likely to have considerably overestimated the treatment effect when compared to the GH response (Lamberg et al, 1976). Although, as in most centres at the present time, our first-line treatment of acromegaly consists of transsphenoidal hypophysectomy, external irradiation remains as a useful option in subjects who are either inadequately treated or are unsuitable candidates for the procedure.…”

Growth Hormone Secreting Pituitary Adenoma: Clinical Aspects and Surgical Outcome

“…8,25 On the other hand, they show that additional drug therapy is often required during the early postirradiation period because of the slow onset of the therapeutic effect of radiotherapy. 15 Although up to 50% of the patients have been estimated to suffer from secondary pituitary insufficiency after radiotherapy, 15 none of our patients developed this complication, probably because our follow-up period was relatively short.…”

“…8,25 On the other hand, they show that additional drug therapy is often required during the early postirradiation period because of the slow onset of the therapeutic effect of radiotherapy.…”