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At least 199 records · Page 11Linked to original sources
PubMed1984

Delayed sequelae of pituitary irradiation.

Since 1958, 781 patients at Lawrence Berkeley Laboratory have received helium-particle stereotactic radiosurgery to the adenohypophysis. Autopsy findings in 15 of these patients are reported. Ten patients received pituitary radiation (average dose, 116 Gy in six fractions) for progressive neovascularization retinopathy due to diabetes mellitus. Evidence of a time-dependent course of progressive fibrosis in their pituitary glands was found. Five patients were treated for eosinophilic adenomas. Although they had lower average doses of radiation (56 Gy in six fractions), their pituitary glands showed cystic cavitation of the adenomas. The adenomas thus appeared more radiosensitive than the normal pars anterior, which, in turn, was more radiosensitive than the adjacent neurohypophysis. No significant radiation changes were found in the surrounding brain or cranial nerves. The endocrine organs under pituitary control showed varying degrees of atrophy, and clinical tests revealed progressive hypofunction. It was concluded that charged-particle therapy produced a sharply delineated focal radiation lesion confined to the pituitary gland but did not cause injury to the critical structures of the surrounding central nervous system.

Acromegaly↗
PubMed1978

Recent advances in diagnosis and management of galactorrhea.

Using prolactin suppression (L-dopa) and provocative (thorazine) tests along with the clomid test the intactness of hypothalamico-pituitary axis was assessed in a group of eight patients with galactorrhea syndrome. Pituitary neoplasm was suspected in three cases on the basis of elevated plasma prolactin and its abnormal response to L-dopa, thorazine, and clomid tests. Trans-sphenoidal exploration of the pituitary gland in these three cases confirmed the diagnosis. In these cases, however, the commonly used parameters for evaluation of the pituitary gland (skull X ray, visual field measurement, echoencephalogram, etc.) failed to reveal the presence of the pituitary lesions. In two of the three cases, normal menses recurred following extirpation of the tumors and conception was achieved successfully. In the remaining patient the operation failed to remove the entire pituitary lesion and it was necessary to irradiate the pituitary gland as the patient continued to have persistent galactorrhea and hyperprolactinemia. The importance of the prolactin assay, and its response to stimulation and suppression tests for proper evaluation of galactorrhea was fully discussed.

Adult↗
PubMed1976

Responsiveness of growth hormone release in acromegalics after irradiation or hypophysectomy.

Effects of X-ray irradiation to the pituitary and transfrontal hypophysectomy were evaluated on the responsiveness of plasma growth hormone (GH) to exogenous stimuli in 8 patients with acromegaly. As exogenous stimuli, arginine, TRH, LH-RH and L-dopa were administered. In 2 out of 3 patients treated with Liniac irradiation, the responsiveness to arginine was essentially unchanged, while in the third patient positive response to arginine disappeared after therapy. Of 2 patients who received a combination of hypophysectomy and Liniac irradiation, the responsiveness to arginine, TRH, LH-RH and L-dopa did not change in 1 patient, but in the other it was observed that negative response to L-dopa became positive after the treatment, remaining the unchanged responsiveness to arginine, TRH, and LH-RH. In 3 hypophysectomized patients, little change in responses to the above 4 stimuli was observed. In summary, out of 22 pairs of responses (pre- and post-therapy) examined 20 were not altered. In 11 pairs of responses (pre- and post-irradiation) particularly, 10 were essentially unchanged. It might be concluded that the responsiveness of GH to exogenous stimuli in acromegalics would not be affected by irradiation or transfrontal hypophysectomy.

Acromegaly↗
PubMedDate not supplied

Gamma irradiation effects on human growth hormone producing pituitary adenoma tissue. An analysis of morphology and hormone secretion in an in vitro model system.

Irradiation-induced effects on pituitary cell morphology and secretion of growth hormone (GH) and prolactin (PRL) have been analysed using an in vitro system. Specimens for organ culture were obtained from three patients with pituitary tumours causing acromegaly but with different clinical activity of disease. Specimens were followed in vitro 1 h - 6 days after single-dose gamma irradiations (60Co) with 70, 100 and 150 Gy, respectively. These doses are used in clinical work for the stereotactic radiosurgery of pituitary adenomas. Considerable fluctuations in hormone secretion/release occurred during the first 24 h after irradiation. Following 70 Gy single dose, the GH secretion increased slightly a few days after irradiation, having been at a minimum level 24 h after exposure. When using dose of 100 and 150 Gy, however, no such increased secretion with time after irradiation was indicated. All three tumors showed individual differences concerning irradiation-induced morphological damage. Only a minor variation occurred between specimens from the same tumour. In specimens from all tumours, irrespective of dose, minor morphological changes were observed 3-5 h after irradiation. Thereafter an individual response to irradiation became apparent. One tumour displayed maximum cell damage 24 h after irradiation with 70 Gy, showing severe oedema and damage to cell organelles. The other two adenomas were only slightly damaged following irradiation with 70, 100 and 150 Gy. Numerous morphologically normal or near-normal cells were found in all specimens from the three tumours 6 days after irradation. An individual sensitivity to irradiation of pituitary tumours in vitro is documented. The great number of surviving pituitary tumour cells one week after irradiation--many with an intact ultrastructure and containing hormone granules--indicated an initial high degree of radioresistance.

Acromegaly↗
PubMed1975

The Jewish Hospital of St. Louis therapeutic grand rounds no. 9. Diagnosis and therapy of acromegaly.

Acromegaly, the clinical expression of chronic hypersecretion of growth hormone, develops insidiously and is too often not recognized until the disease is advanced. However, a useful screening procedure, the measurement of serum growth hormone after an oral glucose load, is available. Though evidence suggesting that acromegaly may be a disorder of defective hypothalamic regulation of pituitary growth hormone secretion has accumulated, the pathogenesis of the diease is not sufficiently understood to permit consistently effective medical therapy. Current therapy, therefore, is directed toward destruction of growth hormone producing pituitary tissue. Patients with major suprasellar extension and chiasmal compression usually require transfrontal surgery. Patients without major suprasellar extension can be treated with external irradiation or with transsphenoidal surgery. It is our current practice to limit the former to young patients withe relatively modest elevation of the serum growth hormone concentration.

Acromegaly↗
PubMed1976

Body composition and skeletal metabolism following pituitary irradiation in acromegaly.

The change in body composition in acromegaly that resulted from pituitary irradiation was examined using the technic of total body neutron activation analysis. Before treatment, increased ratios of total body P:Ca, P:K and Na:K were noted. After pituitary irradiation, the total body levels of P, Na and K were reduced in a proportion that indicated restoration of body composition towards normal. Skeletal mass (total body calcium) decreased into the range observed in osteoporosis in several patients. Trabecular bone mass, as reflected by the Singh Index, was consistently reduced, and two patients had vertebral compression fractures. Local bone mass as determined by photon absorptiometry was reduced when the values were normalized for age, sex and body size. It is postulated that in untreated acromegaly there is differential bone remodelling with an increase in cortical bone accompanied by a reduced trabecular bone mass. When reduction of hGH levels is accomplished with treatment, cortical apposition may decrease. Since the increased cortical bone mass probably aids in preventing vertebral compression fractures, the treated acromegalic patient may incur an increased risk of fractures. This risk may be increased further by the hypogonadism which may arise secondary to pituitary irradiation or surgery. It would be prudent to ensure that the hypogonadal acromegalic patient receives an adequate calcium intake and sex hormone replacement therapy.

Acromegaly↗
PubMed1975

The effect of yttrium-90 implantation on endocrine function and visual fields in patients with "functionless" pituitary tumors, with biopsy and radiological findings.

Thirty patients with symptoms from "functionless" pituitary tumours were treated by yttrium-90 implants, and we report here the effects on symptoms, pituitary function and visual fields. On biopsy, about a third of the tumours showed some hormone granules. In the sixteen fully assessed at 1 year, pituitary function was improved in 25%, unchanged in 62-5%, and reduced in 12-5%. Improvement was confined to those in whom gonadotrophin secretion was the only function impaired pre-implant. Visual field defects were present pre-implant in ten patients (twenty eyes); at 1 year post-implant these defects had lessened in 80% and deteriorated in only 5% of eyes. Subsequently, within 5 years of the implant the field defects had worsened or recurred in four patients, all with initially extensive suprasellar projection; further treatment was then given. Remineralization of the sella was seen after implantation in seven cases, with reduction in fossa size in five. Thus pituitary implantation appears to be a practicable and reasonably simple procedure suitable for the treatment of most cases of "functionless" pituitary tumour. The "supressive" doses of irradiation used are adequate to shrink most tumours without loss of pituitary function.

Adenoma↗
PubMed2000

Treatment of pituitary-dependent Cushing's syndrome: long-term results of unilateral adrenalectomy followed by external pituitary irradiation compared to transsphenoidal pituitary surgery.

BACKGROUND: The preferred treatment of Cushing's disease (CD) nowadays is transsphenoidal pituitary surgery (TPS). Prior to TPS, patients at the Leiden University Medical Centre were treated by unilateral adrenalectomy followed by external pituitary irradiation (UAPI). We report on long-term results of both UAPI and TPS and compare remission, relapse rates, and complications. PATIENTS AND METHODS: A retrospective study was carried out on 130 patients with CD. Patients with pituitary macroadenoma were excluded. Eighty-six and 44 patients underwent UAPI and TPS, respectively. Of these patients, 85 and 41 were evaluable for long-term results. RESULTS: Remission following UAPI and TPS was identical at 64% (54/85 and 27/41). Cumulative relapse was also comparable - 17% (9/54) and 22% (6/27), respectively, - for UAPI and TPS, although the mean follow-up periods were different - 21.4 years and 8.5 years, respectively. Cumulative disease-free survival curves after UAPI and TPS are identical until 5 years of follow-up, but diverge thereafter indicating more sustained remissions following UAPI (P = 0.17, Wilcoxon statistic). Pituitary dysfunction following UAPI (36%) and pituitary surgery (55%) likewise did not differ significantly. However, pituitary dysfunction was an immediate event after TPS, whereas it developed after a mean interval of 17.8 years following UAPI.Low-dose dexamethasone testing during follow-up had no value in predicting therapeutic outcome. CONCLUSIONS: The results of unilateral adrenalectomy followed by external pituitary irradiation do not justify that this therapy is totally abandoned in favour of transsphenoidal pituitary surgery. Unilateral adrenalectomy followed by external pituitary irradiation is a valid therapeutic modality for the treatment of Cushing's disease, and could be considered as alternative to bilateral adrenalectomy and under some circumstances to transsphenoidal pituitary surgery.

Adolescent↗
PubMed1994

Stereotactic options in the management of craniopharyngioma.

Multimodality stereotactic techniques were used in the management of 39 patients with craniopharyngiomas in a 12-year interval. Monocystic craniopharyngiomas were treated successfully by intracavitary beta-irradiation using 32P (96% cyst control rate). Solid tumor progression or secondary cyst formation required repeat irradiation, radiosurgery or microsurgery in selected patients. In the future, wider and earlier application of stereotactic techniques may further reduce the still unacceptable morbidity currently associated with initial radical microsurgical resection of craniopharyngiomas.

Adolescent↗
PubMed1991

Results of external pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing's disease.

Fourteen adult patients (10 females and 4 males; age range 20-60 years) with persistent Cushing's disease after transsphenoidal microsurgery were treated with pituitary irradiation. Supervoltage multiportal administration was employed at a total dose of 50 Gy (+/- 0.65 SD). The interval between microsurgery and pituitary irradiation was less than 6 months in 6 patients and more than 6 months in 8. The pituitary-adrenal axis was evaluated postsurgically, before irradiation and every 6 months thereafter. The remaining anterior pituitary function was simultaneously tested. Remission rates at 12 months and 24 months after radiotherapy were 61 and 70%, respectively. Two patients developed TSH deficiency and another gonadotropin deficiency during the follow-up after radiation. We conclude that pituitary irradiation is the treatment of choice for persistent Cushing's disease after unsuccessful surgery because of its high efficiency and low incidence of adverse reactions when compared with other forms of treatment.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[The results of hypophyseal irradiation with a proton beam in acromegaly patients].

The investigation of 26 acromegalic patients long after irradiation of the pituitary body with a proton beam showed clinical and hormonal improvement in 38% of the patients, clinical improvement without complete growth hormone normalization in 46%, and the absence of any effect in 15%. The latter was mainly a result of partial irradiation of pituitary adenoma. Some patients after proton irradiation demonstrated signs of adenohypophyseal functional insufficiency, more marked in patients with a decreased level of Gy (over 5 ng/ml). A conclusion is that proton beam therapy is effective (provided all criteria for patients' eligibility are observed) and can be used as an independent method for the treatment of acromegalic patients.

Acromegaly↗
PubMed1992

Results of continuous long-term intravenous application of octreotide via an implantable pump system in acromegaly resistant to operative and X-ray therapy.

Long term results after surgery for growth hormone (GH)-secreting adenomas indicate only a limited cure rate, particularly in patients with tumours invading the dural boundaries of the sella with suprasellar extension. Since octreotide had become a treatment option, it was used i.v. via an implantable pump system in five patients (age range 24-46 yr) showing symptoms of uncontrolled acromegaly, in spite of previous surgery and X-ray therapy. The octreotide doses used permanently for a cumulative treatment period of 8.8 yr ranged between 300 and 1000 micrograms/24 h. Serial evaluations of clinical findings, 24-h GH and insulin profiles, insulin growth factor-1 (IGF-1), oral glucose tolerance test and pituitary function revealed sustained GH suppression, without interim escape, below 2 ng/ml in two and below 5 ng/ml in three patients, IGF-1 decrease in all with normalization in two patients and no clinically relevant disturbances of carbohydrate tolerance or thyroid-stimulating hormone secretion. In one case of previous unresponsiveness to dopamine agonists i.v. octreotide application for 29 months facilitated later disease control by bromocriptine only. In two patients octreotide was terminated after 15 and 30 months of i.v. administration, respectively, because the effects of irradiation had occurred. For a subgroup of patients with resistant acromegaly continuous i.v. octreotide can be considered as a safe and effective alternative, which increases patients' independency from the inconvenience of daily repeated s.c. injections.

Acromegaly↗
PubMed1994

Long term follow-up of Cushing's disease treated with reserpine and pituitary irradiation followed by subtotal adrenalectomy.

Subtotal adrenalectomy was given to 10 adult patients with Cushing's disease, concurrently with or following therapeutic regimen by long term reserpine administration and pituitary irradiation. In the present study, we describe long term follow-up results. Two patients died after the operation due to acute adrenal crisis and pneumonia, respectively. The other 8 patients achieved clinical and biochemical remissions and were followed for long term. Three patients relapsed 9, 14 or 17 years after achieving remission, two patients developed hypopituitarism 12 or 20 years after and one died of cerebral vascular accident at 64 years, 5 years after the remission. The remaining 2 patients maintained remission for 10 or 18 years, respectively. During the remission periods of 0.5 to 20 years with a mean of 10.1 +/- 6.7 years, 6 of 7 patients examined by 1 mg overnight dexamethasone test showed normal suppressibility of plasma cortisol. Provocative tests of plasma GH by l-arginine infusion and/or insulin-induced hypoglycemia were performed in 6 patients in the early remission period. All of 5 patients in the arginine infusion test and 3 of 5 in the insulin-induced hypoglycemia test showed normal responses. Furthermore, to facilitate prediction of long term response or failure to our therapeutic regimen, long term reserpine administration and pituitary irradiation, pretreatment clinical and biochemical characteristics were analyzed retrospectively in 3 divided groups; the present 10 patients treated with reserpine and pituitary irradiation followed by subtotal adrenalectomy, 11 patients achieving long term remission treated by our regimen alone, and 7 patients failed with our regimen alone. There were no significant factors predictive of response to our regimen. These findings suggest that subtotal adrenalectomy does not lead favorable outcome, however, reserpine administration shows usefulness to improve pituitary functions in treating Cushing's disease.

Adolescent↗
PubMedDate not supplied

[Effect of proton irradiation of the hypophysis on its gonadotropic and thyrotropic functions in patients with prolactinoma].

In order to study the effect of proton beam irradiation on prolactinoma cells and hypophyseal intact cells tests with i.v. administration of TRH (200 micrograms) and LH-RH (100 micrograms) were performed in 16 women with prolactin-secreting adenomas before and in 2 mos.-2 years after irradiation of the pituitary body with a high energy narrow proton beam (1000 MeV) at a dose of 40-120 Gy. A curative therapeutic effect of proton therapy which was low with respect to reproductive function recovery, was combined with lowered functional reserves of hypophyseal thyrotrophs and gonadotrophs. The informative value of the tests with the releasing hormones was shown for the determination of damage of hypophyseal intact cells. The results suggest refractivity of adenomatous lactotrophs to radiation exposure and the hypothalamic level of disorder of ovarian function regulation in this pathology.

Adult↗
PubMed2005

Final adult height and body mass index after cure of paediatric Cushing's disease.

OBJECTIVE: Linear growth data after cure of paediatric Cushing's disease (CD) have been reported infrequently. We evaluated final adult height (FH) and body mass index (BMI) in a cohort of paediatric patients treated successfully for CD. PATIENTS AND METHODS: Fourteen patients (10 male, age range 6.4-16.6 years) fulfilled the diagnostic criteria for CD. All had had transsphenoidal surgery (TSS), combined with pituitary irradiation (RT) (45 Gy in 25 fractions) in six. All were cured (post-TSS cortisol < 50 nmol/l or mean cortisol post-RT < 150 nmol/l). Subjects analysed had bone ages at diagnosis of < 15 'years' (male) and < 13 'years' (female). RESULTS: At diagnosis, height SDS was [mean (range)]-2.5 (-4.2 to -0.8) and body mass index (BMI) SDS +2.7 (0.8-5.1). Following cure, 13 patients had GH deficiency (peak GH < 20 mU/l) and were treated with hGH (+ GnRH analogue in four). Height SDS at FH (n = 10) or latest assessment (n = 4) was -1.3 (-3.9-0.2) and increased compared to diagnosis (P < 0.01). The difference between final or latest height SDS and target height SDS was -1.2 (-3.3-0.5), that is less (P < 0.01) than the difference between the height SDS at diagnosis and target height SDS of -2.4 (-3.9 to -0.5). At final height or latest assessment, BMI SDS was +1.7 (0.4-6.2), being decreased compared to diagnosis (P < 0.05) but greater than the normal population (P < 0.01). CONCLUSION: Catch-up growth was demonstrated in paediatric patients cured from CD, with the majority achieving FH within target height range. Early diagnosis and treatment of GH deficiency is recommended to achieve optimal long-term growth. Excess adiposity remains a potential long-term complication.

Adolescent↗