Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery

OBJECTIVEPituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife radiosurgery (GKRS) for an underlying pituitary adenoma.METHODSThis was a retrospective, institutional review board–approved, single-institution study. A total of 51 patients (23 male, 28 female) treated for pituitary adenoma were included in this neurocognitive study. Twenty-one patients underwent GKRS following transsphenoidal surgery, 22 patients were treated with transsphenoidal surgery alone, and eight patients were conservatively managed or were treated with medical management alone. Comparisons using psychometric tests of general intellectual abilities, memory, and executive functions were made between the treatment groups, between male and female patients, and between patients with Cushing’s disease and those with nonfunctioning adenoma (NFA).RESULTSThe entire patient sample, the NFA group, and the GKRS group scored significantly below expected on measures of both immediate and delayed memory, particularly for visually presented information (p ≤ 0.05); however, there were no significant differences between the patients with Cushing’s disease and those with NFA (t ≤ 0.56, p ≥ 0.52). In those who underwent GKRS, memory scores were not significantly different from those in the patients who did not undergo GKRS (t ≤ 1.32, p ≥ 0.19). Male patients across the sample were more likely to demonstrate impairments in both immediate memory (t = −3.41, p = 0.003) and delayed memory (t = −3.80, p = 0.001) than were female patients (t ≤ 1.09, p ≥ 0.29). There were no impairments on measures of general intellectual functioning or executive functions in any patient group. The potential contributions of tumor size and hormone levels are discussed.CONCLUSIONSOverall, pituitary adenoma patients demonstrated relative impairment in anterograde memory. However, GKRS did not lead to adverse effects for immediate or delayed memory in pituitary adenoma patients. Cognitive assessment of pituitary adenoma patients is important in their longitudinal care.

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Radiosurgery for Cushing's disease after failed transsphenoidal surgery

Journal of Neurosurgery ◽

10.3171/jns.2000.93.5.0738 ◽

2000 ◽

Vol 93 (5) ◽

pp. 738-742 ◽

Cited By ~ 175

Author(s):

Jonas M. Sheehan ◽

Mary L. Vance ◽

Jason P. Sheehan ◽

Dilantha B. Ellegala ◽

Edward R. Laws

Keyword(s):

Gamma Knife ◽

Cushing’S Disease ◽

Tumor Size ◽

Transsphenoidal Surgery ◽

Gamma Knife Radiosurgery ◽

Magnetic Resonance Images ◽

Cushing's Disease ◽

Content Type ◽

Fine Print

Object. Although transsphenoidal surgery has become the standard of care for Cushing's disease, it is often unsuccessful in normalizing cortisol production. In this study the authors investigate the safety and efficacy of gamma knife radiosurgery (GKRS) for Cushing's disease after failed transsphenoidal surgery.Methods. The records of all patients who underwent GKRS at the authors' institution after unsuccessful transsphenoidal surgery for Cushing's disease were retrospectively reviewed. Successful treatment was considered a normal or below-normal 24-hour urinary free cortisol (UFC) level. Records were also evaluated for relapse, new-onset endocrine deficiencies, interval change in tumor size, and visual complications.Forty-three patients underwent 44 gamma knife procedures with follow up ranging from 18 to 113 months (mean 39.1, median 44 months). Normal 24-hour UFC levels were achieved in 27 patients (63%) at an average time from treatment of 12.1 months (range 3–48 months). Three patients had a recurrence of Cushing's disease at 19, 37, and 38 months, respectively, after radiosurgery. New endocrine deficiencies were noted in seven patients (16%). Follow-up magnetic resonance images obtained in 33 patients revealed a decrease in tumor size in 24, no change in nine, and an increase in size in none of the patients. One patient developed a quadrantanopsia 14 months after radiosurgery despite having received a dose of only 0.7 Gy to the optic tract.Conclusions. Gamma knife radiosurgery appears to be safe and effective for the treatment of Cushing's disease refractory to pituitary surgery. Delayed recurrences and new hormone deficiencies may occur, indicating the necessity for regular long-term follow up.

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Early versus late Gamma Knife radiosurgery for Cushing’s disease after prior resection: results of an international, multicenter study

Journal of Neurosurgery ◽

10.3171/2019.12.jns192836 ◽

2020 ◽

pp. 1-9

Author(s):

Adomas Bunevicius ◽

Hideyuki Kano ◽

Cheng-Chia Lee ◽

Michal Krsek ◽

Ahmed M. Nabeel ◽

...

Keyword(s):

Pituitary Adenoma ◽

Gamma Knife ◽

Cushing’S Disease ◽

Cox Regression ◽

Remission Rate ◽

Gamma Knife Radiosurgery ◽

Cushing's Disease ◽

Optimal Time ◽

Incomplete Resection ◽

Remission Rates

OBJECTIVEThe optimal time to perform stereotactic radiosurgery after incomplete resection of adrenocorticotropic hormone (ACTH)–producing pituitary adenoma in patients with Cushing’s disease (CD) remains unclear. In patients with persistent CD after resection of ACTH-producing pituitary adenoma, the authors evaluated the association of the interval between resection and Gamma Knife radiosurgery (GKRS) with outcomes.METHODSPooled data from 10 institutions participating in the International Radiosurgery Research Foundation were used in this study.RESULTSData from 255 patients with a mean follow-up of 65.59 ± 49.01 months (mean ± SD) were analyzed. Seventy-seven patients (30%) underwent GKRS within 3 months; 46 (18%) from 4 to 6 months; 34 (13%) from 7 to 12 months; and 98 (38%) at > 12 months after the resection. Actuarial endocrine remission rates were higher in patients who underwent GKRS ≤ 3 months than when treatment was > 3 months after the resection (78% and 65%, respectively; p = 0.017). Endocrine remission rates were lower in patients who underwent GKRS at > 12 months versus ≤ 12 months after the resection (57% vs 76%, respectively; p = 0.006). In multivariate Cox regression analyses adjusted for clinical and treatment characteristics, early GKRS was associated with increased probability of endocrine remission (hazard ratio [HR] 1.518, 95% CI 1.039–2.218; p = 0.031), whereas late GKRS (HR 0.641, 95% CI 0.448–0.919; p = 0.015) was associated with reduced probability of endocrine remission. The incidence of some degree of new pituitary deficiency (p = 0.922), new visual deficits (p = 0.740), and other cranial nerve deficits (p = 0.610) was not significantly related to time from resection to GKRS.CONCLUSIONSEarly GKRS is associated with an improved endocrine remission rate, whereas later GKRS is associated with a lower rate of endocrine remission after pituitary adenoma resection. Early GKRS should be considered for patients with CD after incomplete pituitary adenoma resection.

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Gamma knife radiosurgery in patients with Cushing’s disease: Comparison of aggressive pituitary corticotroph tumor versus corticotroph adenoma

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.106151 ◽

2020 ◽

Vol 197 ◽

pp. 106151

Author(s):

Müjdat Kara ◽

Mustafa Güdük ◽

Yavuz Samanci ◽

Meltem Yilmaz ◽

Meriç Şengöz ◽

...

Keyword(s):

Gamma Knife ◽

Cushing’S Disease ◽

Gamma Knife Radiosurgery ◽

Cushing's Disease ◽

Corticotroph Adenoma

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PC3 - 142 Gamma Knife Radiosurgery in Patients with Persistent Acromegaly or Cushing’s Disease: Long-Term Risk of Hypopituitarism

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.393 ◽

2016 ◽

Vol 43 (S4) ◽

pp. S22-S22

Author(s):

O. Cohen-Inbar

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Cushing’S Disease ◽

Hormone Replacement ◽

Gamma Knife Radiosurgery ◽

Common Adverse Effect ◽

Cushing's Disease ◽

Pituitary Hormone

For patient with a recurrent or residual acromegaly or Cushing’s disease (CD) after resection, Gamma knife radiosurgery (GKRS) is often used. Hypopituitarism is the most common adverse effect after GKRS treatment. The paucity of studies with long-term follow up has hampered understanding of the latent risks of hypopituitarism in patients with a Acromegaly or CD. We report the long-term risks of hypopituitarism for patients treated with GKRS for Acromegaly or CD. Methods: From a prospectively created, IRB approved database, we identified all patients with a Acromegaly or CD treated with GKRS at the University of Virginia from 1989 to 2008. Only patients with a minimum endocrine follow up of 60 months were included. The median follow-up is 159.5 months (60.1-278). Thorough radiological and endocrine assessments were performed immediately before GKRS and at regular follow-up intervals. New onset of hypopituitarism was defined as pituitary hormone deficits after GKRS requiring corresponding hormone replacement. Results: 60 patients with either Acromegaly or CD were included. Median tumor volume at time of GKRS was 1.3 cm3 (0.3-13.4), median margin dose was 25 Gy (6-30). GKRS induced new pituitary deficiency occurred in 58.3% (n=35) of patients. Growth Hormone deficiency was most common (28.3%, n=17). The actuarial overall rates of hypopituitarism at 3, 5, and 10 years were 10%, 21.7%, and 53.3%, respectively. The median time to hypopituitarism was 61 months after GKRS (range, 12-160). Cavernous sinus invasion of the tumor was found to correlate with the occurrence of a new or progressive hypopituitarism after GKRS (p=0.018). Conclusions: Delayed hypopituitarism increases as a function of time after radiosurgery. Hormone axes appear to vary in terms of radiosensitivity. Patients with adenoma in the cavernous sinus are more prone to develop loss of pituitary function after GKRS.

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Pregnancy in Cushing’s disease shortly after treatment by gamma-knife radiosurgery

Journal of Endocrinological Investigation ◽

10.1007/bf03347539 ◽

2004 ◽

Vol 27 (10) ◽

pp. 954-956 ◽

Cited By ~ 5

Author(s):

I. Chiodini ◽

M. Losa ◽

G. Pavone ◽

V. Trischitta ◽

A. Scillitani

Keyword(s):

Gamma Knife ◽

Cushing’S Disease ◽

Gamma Knife Radiosurgery ◽

Cushing's Disease

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The Value of Intraoperative Cytology and ACTH Measurement of Pituitary Adenoma during Transsphenoidal Surgery in Cushing's Disease

Japanese Journal of Neurosurgery ◽

10.7887/jcns.11.9 ◽

2002 ◽

Vol 11 (1) ◽

pp. 9-13

Author(s):

Masamichi Kurosaki ◽

Takashi Watanabe ◽

Jorg Flitsch ◽

Dieter K. Ludecke

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Transsphenoidal Surgery ◽

Cushing's Disease ◽

Intraoperative Cytology

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Gamma Knife Radiosurgery in Patients with Cushing's Disease and Nelson's Syndrome

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1600689 ◽

2017 ◽

Vol 78 (S 01) ◽

pp. S1-S156

Author(s):

Joshua Hughes ◽

Michael Link ◽

Bruce Pollock

Keyword(s):

Gamma Knife ◽

Cushing’S Disease ◽

Gamma Knife Radiosurgery ◽

Cushing's Disease ◽

Nelson’S Syndrome ◽

Nelson's Syndrome

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Outcomes of Cushing’s disease following Gamma Knife radiosurgery: effect of a center’s growing experience and era of treatment

Journal of Neurosurgery ◽

10.3171/2019.12.jns192743 ◽

2020 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Adomas Bunevicius ◽

Darrah Sheehan ◽

Mary Lee Vance ◽

David Schlesinger ◽

Jason P. Sheehan

Keyword(s):

Gamma Knife ◽

Cushing’S Disease ◽

Treatment Success ◽

Gamma Knife Radiosurgery ◽

Cushing's Disease ◽

Tumor Control ◽

Complication Rates ◽

Cox Regression Analysis ◽

Remission Rates ◽

Early Cohort

OBJECTIVEStereotactic radiosurgery (SRS) is used for the management of residual or recurrent Cushing’s disease (CD). Increasing experience and technological advancements of Gamma Knife radiosurgery (GKRS) systems can impact the outcomes of CD patients. The authors evaluated the association of their center’s growing experience and the era in which GKRS was performed with treatment success and adverse events in patients with CD.METHODSThe authors studied consecutive patients with CD treated with GKRS at the University of Virginia since installation of the first Gamma Knife system in March 1989 through August 2019. They compared endocrine remission and complication rates between patients treated before 2000 (early cohort) and those who were treated in 2000 and later (contemporary cohort).RESULTSOne hundred thirty-four patients with CD underwent GKRS during the study period: 55 patients (41%) comprised the early cohort, and 79 patients (59%) comprised the contemporary cohort. The contemporary cohort, compared with the early cohort, had a significantly greater treatment volume, radiation prescription dose, maximal dose to the optic chiasm, and number of isocenters, and they more often had cavernous sinus involvement. Endocrine remission rates were higher in the contemporary cohort when compared with the early cohort (82% vs 66%, respectively; p = 0.01). In a Cox regression analysis adjusted for demographic, clinical, and SRS characteristics, the contemporary GKRS cohort had a higher probability of endocrine remission than the early cohort (HR 1.987, 95% CI 1.234–3.199; p = 0.005). The tumor control rate, incidence of cranial nerve neuropathy, and new anterior pituitary deficiency were similar between the two groups.CONCLUSIONSTechnological advancements over the years and growing center experience were important factors for improved endocrine remission rates in patients with CD. Technological aspects and results of contemporary Gamma Knife systems should be considered when counseling patients, planning treatment, and reporting treatment results. Studies exploring the learning curve for GKRS are warranted.

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