Long-Term Results of Stereotactic Radiosurgery in Secretory Pituitary Adenomas

Castinetti, Frédéric; Nagai, Mariko; Morange, Isabelle; Dufour, Henry; Caron, Philippe; Chanson, Philippe; Cortet‐Rudelli, Christine; Kuhn, Jean-Marc; Conte-Devolx, B.; Régis, Jean; Brue, Thierry

doi:10.1210/jc.2008-2772

Cited by 169 publications

(117 citation statements)

References 36 publications

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“…The present study has thus demonstrated that an acceptable treatment outcome can be achieved with FSRT, while the patients were still on medication, which is also in keeping with a demonstrated lack of significant difference between patients treated or not treated with somatostatin analogues (40). Current recommendations, however, seem to advise withholding medication during the radiation (6), and evaluation of biochemical measurements pre radiation without medical therapy seems to be a predictive factor of remission (40). However, only a prospective randomised study with sufficient power can clarify this issue.…”

Section: Authorssupporting

confidence: 87%

“…Due to a slowly progressing effect of radiation on the pituitary gland, the highest incidence of hypopituitarism has been reported in the series of patients with the longest follow-up (38,39). Risk of deficiency, though, seems maximal during the first 96 months after radiation (40). Evaluation of post-radiation hypopituitarism is difficult because of confounding factors such as previous surgery and/or radiation and differences in radiation of the tumour margin (38).…”

Section: Authorsmentioning

confidence: 99%

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Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

Roug¹,

Rasmussen²,

Juhler³

et al. 2010

European Journal of Endocrinology

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Aim: To evaluate the effect of fractionated stereotactic radiotherapy (FSRT) in acromegaly in a retrospective analysis. Patients and methods: Thirty-four patients (17 females, median 43 years (range 30-74)) with acromegaly were treated with FSRT (conformal dynamic arcing, dose 54 Gy, 27-30 fractions) between January 1998 and April 2007. Of the 34 patients, 32 had undergone transsphenoidal adenotomy, and 28 were on medical therapy before FSRT. Patients on medical therapy continued this during and after the irradiation. The treatment was gradually decreased/withdrawn after careful assessment. Results: Magnetic resonance scanning of the pituitary gland 34 months (median, range 11-95) after irradiation showed stable or reduced volume of the remaining tumour tissue in 31 of 34 patients (91%). Seventeen patients (50%) were biochemically controlled (normalised nadir GH during oral glucose tolerance test and IGF1 !C2 S.D.) 30 months after FSRT (median, range 6-60), and ten of them had true biochemical remission (off medical therapy) 30 months after FSRT (median, range 12-69). Of 28 patients with one or more functioning pituitary axes before irradiation, 8 (29%) developed further deficit of one or two pituitary axes 48 months (median, range 6-102) after FSRT. Of 34 patients, 20 still required medical treatment for acromegaly at the end of this study, mainly those with a short follow-up period after irradiation. Conclusion: The FSRT seems promising in terms of treatment of acromegaly. Longer follow-up is, however, needed to assess the overall efficacy and safety of FSRT for acromegaly.

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Section: Authorssupporting

confidence: 87%

Section: Authorsmentioning

confidence: 99%

Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

Roug¹,

Rasmussen²,

Juhler³

et al. 2010

European Journal of Endocrinology

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“…Pituitary irradiation is one alternative but, despite substantial progress in radiotherapeutic methods, efficacy is not immediate and there are significant side effects (6). Bilateral adrenalectomy immediately controls excess cortisol but requires lifelong steroid-substitution therapy.…”

Section: Introductionmentioning

confidence: 99%

Efficiency and tolerance of mitotane in Cushing's disease in 76 patients from a single center

Baudry

Coste

Khalil

et al. 2012

European Journal of Endocrinology

164

118

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Context: Alternatives to transsphenoidal pituitary surgery may be required in Cushing's disease (CD) as a first-or second-line treatment. Mitotane is a potent anti-cortisolic drug but has been rarely investigated in the treatment of CD. Objective: Evaluation of the efficacy and tolerance of mitotane in CD patients. Design and setting: Retrospective analysis of 76 patients treated with mitotane from 219 patients diagnosed with CD between 1993 and 2009 in a single center. Main outcome measure: Remission was defined as normalization of 24-h urinary free cortisol (24-h-UFC). Results: Remission was achieved in 48 (72%) of the 67 long-term treated patients, after a median time of 6.7 (5.2-8.2) months. Mean plasma mitotane concentration at the time of remission was 10.5G8.9 mg/l, with a mean daily dose of 2.6G1.1 g. A negative linear relationship was observed between plasma mitotane concentration and 24-h-UFC (P!0.0001). Seventeen of 24 (71%) patients with durable remission subsequently experienced recurrence, after a median time of 13.2 (5.0-67.9) months. At the time of treatment discontinuation, ACTH concentration was statistically associated with a lower recurrence probability (hazard ratios 0.57 (0.32-1.00), PZ0.05). Intolerance leading to treatment discontinuation occurred in 19 patients (29%). A pituitary adenoma became identifiable during mitotane treatment in 12 (25%) of the 48 patients with initial negative pituitary imaging allowing subsequent transsphenoidal surgery. Conclusion: Mitotane is useful at different stages of CD. Mitotane dose adjustment based on plasma concentration monitoring and side effects could control hypercortisolism in the majority of CD patients.

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“…43 Tumor growth may occur in 3-5 % of subjects, though it is unclear whether this reflects the natural history of adenoma growth or loss of IGF-1 feedback. 44,45 It is recommended that patients undergo monitoring with serial MRI scans; for example, at 6-month intervals during the first year and then annually. Pegvisomant therapy is associated with abnormalities in liver function tests; in the German Pegvisomant Observational Study, transaminase levels greater than three times normal were noted in 5.2 % of subjects.…”

Section: Pegvisomantmentioning

confidence: 99%

Diagnosis and Management of Acromegaly in 2014 (Update from 2012)

Katznelson¹

2015

European Endocrinology

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Acromegaly is an uncommon disorder that, in the vast majority of cases, is the result of a growth hormone (GH)-secreting pituitary adenoma. Because tumors are often macroadenomas at the time of diagnosis, there may be a number of signs and symptoms related to local mass effects, including headache, visual field loss, ophthalmoplegia, and hypopituitarism. Chronic GH and insulin-like growth factor 1 (IGF-1) hypersecretion can lead to soft tissue and bone overgrowth manifestations, medical comorbidities, and accompanying clinical features. Medical comorbidites include arthropathy, cardiomegaly, type 2 diabetes, hypertension, sleep apnea syndrome, and colon polyps. In addition, acromegaly is associated with premature mortality, primarily owing to cardiovascular disease. Appropriate therapy of acromegaly can lead to improvement in these comorbidities and reversal of the premature mortality risk. This current review is an update to the 2012 summary. Diagnosis of AcromegalyThe diagnosis of acromegaly begins with a clinical suspicion by the physician that the patient has this disease. Typical physical examination findings include hand and foot enlargement or facial bone enlargement and acral/soft tissue changes. Of note, subjects usually do not present with a chief complaint related to acral growth. In women, the most common presenting complaint is amenorrhea. 2Biochemical testing involves measurement of GH and IGF-1. GH, produced by the somatotroph cells of the pituitary gland in a pulsatile fashion, circulates and stimulates hepatic secretion of IGF-1. In the recent Endocrine Society guidelines on the approach to acromegaly, it was recommended that a serum IGF-1 level be measured in subjects with acral manifestations. Owing to the lack of agreement between assays and the lack of validated normal ranges for IGF-1, 3,4 the same assay should be used in the same patient for serial measurement. 5A random GH measurement was not considered useful in diagnosis because of the lack of a well-defined normal or safe range, although a markedly elevated random GH level is certainly consistent with the disease. Additionally, in subjects with elevated or equivocal serum IGF-1 concentrations, the recent acromegaly guidelines recommended confirmation of the diagnosis with a lack of suppression of GH to less than 1 mcg/l following an oral glucose load. 6 In a patient with signs and symptoms of acromegaly and an elevated IGF-1 value, an oral glucose tolerance test (OGTT) may not be necessary for diagnosis. In the setting of a clinical suspicion but discordant values, such as an elevated IGF-1 and normal GH value (i.e., suppressible with OGTT), the subject likely has early stage acromegaly. 7After diagnosis of acromegaly, a magnetic resonance imaging (MRI) scan of the sella should be obtained to determine tumor size, location, and invasiveness. Visual field testing is performed if the tumor is touching or compressing the optic chiasm. A thorough ophthalmologic examination should be performed if the patient describes diplopia and the tumo...

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Long-Term Results of Stereotactic Radiosurgery in Secretory Pituitary Adenomas

Abstract: SR is an effective and safe primary or adjunctive treatment in selected patients with secreting pituitary adenomas.

Cited by 169 publications

References 36 publications

Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

Fractionated stereotactic radiotherapy in patients with acromegaly: an interim single-centre audit

Efficiency and tolerance of mitotane in Cushing's disease in 76 patients from a single center

Diagnosis and Management of Acromegaly in 2014 (Update from 2012)

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