Radiation-induced hypopituitarism

Fernández, Alberto; Brada, Michael; Zabuliene, Lina; Karavitaki, Niki; Wass, John

doi:10.1677/erc-08-0231

Cited by 81 publications

(75 citation statements)

References 292 publications

(118 reference statements)

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“…However, although radiotherapy is clearly effective in preventing recurrence/regrowth in this setting (5-7, 11, 31, 42, 43) (Table 4), its place in the management of patients with pituitary tumors is controversial. Indeed, radiotherapy, at least when delivered with conventional modalities, carries a risk of hypopituitarism, secondary brain tumors, stroke, and possibly neurocognitive or neuropsychological impairment (13,17,44). We observed no neurological adverse effects in this series, likely because conformational fractionated irradiation was used in the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, even after complete or near complete surgical resection, NFMAs regrow in 12-58% of patients within 5 years (5)(6)(7)(8), and medical therapy with dopamine agonists or somatostatin analogs has a variable and often limited impact on the risk of recurrence (9). Some centers consider immediate postoperative radiation therapy in an attempt to prevent tumor regrowth (6,(10)(11)(12), but this approach carries a risk of complications such as hypopituitarism (13), cerebrovascular disease (14,15), potential neurocognitive dysfunction (16), and a low but welldocumented long-term risk of secondary intracranial tumors (17).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients

Brochier

Galland²,

Kujas³

et al. 2010

European Journal of Endocrinology

174

117

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Context: Adequate postoperative management of nonfunctioning pituitary macroadenomas (NFMAs) remains a challenge for the clinician. Objective: To identify predictive factors of NFMA relapse after initial surgery. Patients and methods: This retrospective study included 142 patients operated for an NFMA in two academic centers (CHU Bicêtre in France and UCL St Luc in Belgium). The rate of tumor relapse, defined as recurrence after total surgical resection or regrowth of a surgical remnant, as well as predictive factors was analyzed. Results: During a mean follow-up of 6.9 years, 10 out of 42 patients (24%) who had complete macroscopic resection of their tumor had recurrence, and 47 out of 100 patients (47%) with a surgical remnant experienced regrowth. The overall relapse rates were 25, 43, and 61% at 5, 10, and 15 years respectively. Invasion of the cavernous sinus, absence of immediate radiotherapy after the first neurosurgery, and immunohistochemical features of the tumor (mainly positive immunostaining for several hormones or for hormones other than gonadotropins) were independent risk factors for tumor relapse. Incomplete excision was only associated with relapse when invasion was withdrawn from the analysis, suggesting that these two factors are closely linked. Conclusion: NFMAs frequently recur/regrow after initial surgery, particularly when tumor is invasive, precluding complete removal. Immunohistochemical features such as positive immunostaining for several hormones or for hormones other than gonadotropins could help to predict undesirable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients

Brochier

Galland²,

Kujas³

et al. 2010

European Journal of Endocrinology

174

117

View full text Add to dashboard Cite

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“…The prevalence of cerebrovascular accidents increases with time from exposure: 4% at 5 years, 11% at 10 years, and 21% at 20 years (Brada et al 1999). Rarer occurrences are optic neuropathy (also occurring about 15 years after irradiation in 1-2% of cases; Fernandez et al 2009) and brain necrosis -an exceptional side effect. As most of these complications become apparent many years after the irradiation, more data are available about conventional RT.…”

Section: Medical Treatmentmentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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Acromegaly (ACM) is a chronic, progressive disorder caused by the persistent hypersecretion of GH, in the vast majority of cases secreted by a pituitary adenoma. The consequent increase in IGF1 (a GH-induced liver protein) is responsible for most clinical features and for the systemic complications associated with increased mortality. The clinical diagnosis, based on symptoms related to GH excess or the presence of a pituitary mass, is often delayed many years because of the slow progression of the disease. Initial testing relies on measuring the serum IGF1 concentration. The oral glucose tolerance test with concomitant GH measurement is the gold-standard diagnostic test. The therapeutic options for ACM are surgery, medical treatment, and radiotherapy (RT). The outcome of surgery is very good for microadenomas (80-90% cure rate), but at least half of the macroadenomas (most frequently encountered in ACM patients) are not cured surgically. Somatostatin analogs are mainly indicated after surgical failure. Currently their routine use as primary therapy is not recommended. Dopamine agonists are useful in a minority of cases. Pegvisomant is indicated for patients refractory to surgery and other medical treatments. RT is employed sparingly, in cases of persistent disease activity despite other treatments, due to its long-term side effects. With complex, combined treatment, at least three-quarters of the cases are controlled according to current criteria. With proper control of the disease, the specific complications are partially improved and the mortality rate is close to that of the background population.

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“…In pNFPAs, pituitary conventional radiotherapy significantly reduces the risk of tumor regrowth with recurrence-free survival of between 87.5 and 97% at 10 years and between 72 and 92% at 20 years [6,12,13,14,15,16,17], but this approach carries a risk of complications such as hypopituitarism [18]. Irradiation results in hypopituitarism in at least 40–50% of the patients [13,19,20] and visual complications are reported in 1–3% [13,19,21,22], along with cerebrovascular disease [23,24] and potential neurocognitive dysfunction [25].…”

Section: Introductionmentioning

confidence: 99%

Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

et al. 2012

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Objective: Previous studies attempting to define the natural history of postoperative nonfunctioning pituitary adenomas (pNFPAs) were somewhat limited by selection bias and/or small numbers and/or lack of consistency among the study findings. The aim of this study was to scrutinize the literature in order to analyze the natural history of pNFPAs. Methods: Electronic database including MEDLINE, PubMed and Cochrane CENTRAL were searched. The literature relating to the patients with pNFPAs without postoperative radiotherapy and pharmacotherapy was collected. Eligible studies reported on the rate of tumor recurrence, the tumor growth-free survival rate (TGFSR) at 5 and 10 years, and/or the residual tumor volume doubling time (TVDT). Results: 19 studies met the criteria. The pNFPAs were divided into two groups: the pooled recurrence rate of group I without detectable residual tumor (371 patients) was 12% (95% CI 6–19%), the TGFSR at 5 and 10 years were 96% (95% CI 89–99%) and 82% (95% CI 65–94%), respectively. The pooled recurrence rate of group II with residual tumor (600 patients) was 46% (95% CI 36–56%), the TGFSR at 5 and 10 years were 56% (95% CI 41–71%) and 40% (95% CI 27–53%), respectively. The mean TVDT was 3.4 years (95% CI 2.4–4.5 years). Conclusions: pNFPAs, with or without detectable residual tumor, need stratification of treatment and radiological/endocrinological follow-up strategy. According to the TVDT, residual tumor regrowth is very slow, which permits an extensive and safe follow-up program for most patients.

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Radiation-induced hypopituitarism

Cited by 81 publications

References 292 publications

Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients

Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

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