Gamma knife stereotactic radiosurgery for acromegaly

Objective: The aim of this study was to determine the frequency and characteristics of severe GH deficiency (sGHD) in patients after treatment of acromegaly by surgery alone. Design and methods: One hundred and eighty-six patients fulfilling the criteria for cure of acromegaly were examined by GH-releasing peptide-2 stimulation test or arginine stimulation test as well as oral glucose tolerance test (GTT). In addition, the Japanese adult hypopituitarism questionnaire was completed to determine the quality of life (QoL). Results: sGHD was found in 17 patients (9.1%; the GH-deficient group), and not found in 169 patients (90.9%; the GH-sufficient group). There were no significant differences in preoperative serum GH levels, IGF1 levels, incidence of hyperprolactinemia, tumor volumes, or incidence of microadenoma between the two groups. Upon follow-up examination, IGF1 levels and Z-scores of IGF1 levels were significantly lower in the GH-deficient group than in the GH-sufficient group, whereas neither basal GH levels nor nadir GH levels during 75 g GTT were significantly different between the two groups. Moreover, sGHD patients had a substantially higher incidence of multiple pituitary failures (17.6 vs 2.4%) and dyslipidemia (60 vs 16.2%). sGHD patients had a substantially poorer conditionrelated QoL. Conclusions: This is the first large-scale, single-center, clinical study to evaluate sGHD in patients after cure of acromegaly by surgery alone. This study found that sGHD occurred in w9% of patients and assessment of GHD by stimulation tests is critical after successful treatment of acromegaly by surgery.

Section: Introductionmentioning

confidence: 99%

GH deficiency in patients after cure of acromegaly by surgery alone

Yamada¹,

Fukuhara²,

Nishioka³

et al. 2011

“…Although with a minor frequency, the same is true also for radiosurgery (2). Regarding acromegalic patients, it is known that RT may induce GHD in about 30-50% of treated patients (3)(4)(5) and radiosurgery in about 6% (6). On the contrary, few and contrasting studies conducted on small series of patients are present in the literature about the impact of transsphenoidal surgery (S) alone (4,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments

Ronchi¹,

Giavoli²,

Ferrante³

et al. 2009

Objective: Radiotherapy (RT) for pituitary adenomas, including GH-secreting ones, frequently leads to GH deficiency (GHD). Data on the effects of surgery alone (S) on dynamic GH secretion are limited. The aim of the study was to investigate the occurrence of GHD in acromegalic patients treated with different therapeutic options. Design and methods: Fifty-six patients in remission from acromegaly, (33 F & 23 M, age: 54G13 years, body mass index (BMI): 28.4G4.1 kg/m 2 , 21 with adequately substituted pituitary deficiencies) treated by S alone (nZ33, group 1) or followed by RT (nZ23, group 2), were investigated for GHD by GHRH plus arginine testing, using BMI-adjusted cut-offs. Several metabolic and cardiovascular parameters (waist circumference, body fat percentage, blood pressure, fasting and post-oral glucose tolerance test glucose, HbA1c, insulin resistance and lipid profile) were evaluated in all the patients and 28 control subjects with known diagnosis of GHD. Results: Serum GH peak after challenge was 8.0G9.7 mg/l, without any correlation with post-glucose GH nadir and IGF-1 levels. The GH response indicated severe GHD in 34 patients (61%) and partial GHD in 15 patients (27%). IGF-1 were below the normal range in 14 patients (25%). The frequency of GHD was similar in the two treatment groups (54% in group 1 and 70% in group 2). No significant differences in metabolic parameters were observed between acromegalic patients and controls with GHD. Conclusions: Severe GHD may occur in about 60% of patients treated for acromegaly, even when cured after S alone. Thus, a stimulation test (i.e. GHRH plus arginine) is recommended in all cured acromegalic patients, independently from previous treatment.

“…There are relatively few reports on the effect of this treatment regarding hypersecretion, tumor volume, and adverse effects. The patients underwent a detailed survey similar to our recently published study on 55 patients treated with GKR for acromegaly (6).…”

Section: Introductionmentioning

confidence: 99%

“…Leksell model C gamma knife (Elekta Instruments, Stockholm, Sweden) as described previously (6). Patients accepted for treatment had visible tumors on imaging, with a minimum distance to the optic nerve or chiasm of at least 3 mm.…”

mentioning

confidence: 99%

Gamma knife stereotactic radiosurgery of Nelson syndrome

Vik-Mo

Øksnes

Pedersen

et al. 2009

Self Cite

Objective: Gamma knife radiosurgery (GKR) can be used as primary or adjuvant therapy for the treatment of an ACTH-producing pituitary tumor after bilateral adrenalectomy, called Nelson syndrome (NS). We have examined the effect of GKR on tumor growth and ACTH-hypersecretion, and characterized the adverse events of this treatment in patients with NS. Design: Cross-sectional follow-up study. First, retrospective data pre-and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation. Subjects: Ten patients treated with GKR for NS after previous bilateral adrenalectomy. The mean followup was 7 years. No patient was lost to follow-up. Results: Tumor growth was stopped in all patients. The ACTH levels declined in eight patients, and normalized in one patient. There was a significant drop in ACTH levels, with a half-time of 2.8 years.No patient developed visual field defects or any other cranial nerve dysfunction as a result of treatment. Four patients started hormone substitution therapy during the follow-up period. The substitution therapy of three pituitary axes present at GKR treatment could be stopped during the same period. One patient developed a glioblastoma in the left parieto-occipital region 14 years after GKR, far from the field of treatment. As the radiation level was below 1Gy to this area, it is unlikely that the GKR treatment itself induced the malignant tumor. Conclusion: In patients with NS, GKR is an effective adjuvant treatment, carrying relatively few adverse effects. Although the risk of developing a secondary neoplasia after GKR is present, it is probably extremely low.