Application of stereotactic radiosurgery and radiotherapy in the treatment of Itsenko — Cushing’s disease

2020 ◽  
pp. 57-65
Author(s):  
А. Abdali ◽  
L. I. Astafieva ◽  
Yu. Yu. Trunin ◽  
A. V. Golanov ◽  
P. L. Kalinin ◽  
...  
Keyword(s):  
Literature Review ◽  
Stereotactic Radiosurgery ◽  
Cushing’S Disease ◽  
Pituitary Tumor ◽  
Initial Treatment ◽  
Adrenocorticotropic Hormone ◽  
Surgical Intervention ◽  
Radiation Treatment ◽  
Cushing's Disease ◽  
Modern Methods

Cushing’s disease is caused by a pituitary tumor which causes increased production of adrenocorticotropic hormone, leading to chronic hypersecretion of cortisol by the adrenal cortices. Endoscopic transnasal adenomectomy is the initial treatment of choice with the greatest efficiency for the treatment of the disease. However in the absence of remission or relapse of hypercortisolism after neurosurgical surgery, as well as in cases when surgical intervention cannot be carried due to medical contraindications to surgical intervention, radiation treatment is used as an alternative or adjoining therapy. In this literature review the efficiency of different radiation techniques (the conventional and the modern techniques), as well as possible complications of modern methods of radiosurgery and radiotherapy have been looked for.

scholarly journals Treatment challenges in pediatric Cushing’s disease: Review of the literature with particular emphasis on predictive factors for the disease recurrence

Endocrine ◽  
2019 ◽  
Vol 66 (2) ◽  
pp. 125-136
Author(s):  
Katarzyna Pasternak-Pietrzak ◽  
Elżbieta Moszczyńska ◽  
Mieczysław Szalecki
Keyword(s):  
Predictive Factors ◽  
Cushing’S Disease ◽  
Pituitary Tumor ◽  
Adrenocorticotropic Hormone ◽  
Disease Recurrence ◽  
Cushing's Disease ◽  
Review Of The Literature ◽  
Persistent Disease ◽  
Prompt Treatment ◽  
Current State

Abstract Cushing’s disease (CD) is a rare endocrine condition caused by a corticotroph pituitary tumor that produces adrenocorticotropic hormone. The current state of knowledge of CD treatment is presented in this article including factors that can be helpful in predicting remission and/or recurrence of the disease. The primary goals in CD treatment are quick diagnosis and effective, prompt treatment as the persistent disease is associated with increased morbidity and mortality. Cooperation of a team consisting of experienced pediatrician/adult endocrinologist, neuroradiologist, transsphenoidal neurosurgeon and (if necessary) radiotherapist contribute to the best treatment effects.

Effect of stereotactic radiosurgery before bilateral adrenalectomy for Cushing's disease on the incidence of Nelson's syndrome

2013 ◽  
Vol 119 (6) ◽  
pp. 1493-1497 ◽  
Author(s):  
Gautam U. Mehta ◽  
Jason P. Sheehan ◽  
Mary Lee Vance
Keyword(s):  
Tumor Growth ◽  
Tumor Progression ◽  
Stereotactic Radiosurgery ◽  
Cushing’S Disease ◽  
Pituitary Tumor ◽  
Bilateral Adrenalectomy ◽  
Cushing's Disease ◽  
Cranial Neuropathy ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome

Object Nelson's syndrome (NS) is a significant and frequent risk for patients with Cushing's disease (CD) who undergo bilateral adrenalectomy. A recent study has shown tumor progression in 47% of patients at risk for NS. The authors sought to define the rate of NS in patients who were treated with Gamma Knife stereotactic radiosurgery (GK SRS) prior to bilateral adrenalectomy. Methods Consecutive patients with CD who were treated with GK SRS after pituitary surgery but before bilateral adrenalectomy were included. Serial MRI sequences were analyzed to evaluate for pituitary tumor growth. Clinical evaluations were performed to screen for NS. Follow-up for adrenocorticotropic hormone levels and hormone studies of other pituitary axes was performed. Results Twenty consecutive patients were followed with neuroimaging and clinically for a median of 5.4 years (range 0.6–12 years). One patient (5%) developed pituitary tumor growth consistent with NS 9 months after adrenalectomy. By Kaplan-Meier analysis, progression-free survival was 94.7% at 1, 3, and 7 years. No predisposing factors were identified for the tumor progression. Two patients developed new pituitary dysfunction and no patient developed cranial neuropathy or visual deficit after GK SRS. Conclusions These findings suggest that GK SRS not only serves a role as second-line therapy for CD, but that it also provides prophylaxis for NS when used before bilateral adrenalectomy.

Pediatric cyclical Cushing’s disease: a case report and literature review

2020 ◽  
Vol 0 (1) ◽  
pp. 47-56
Author(s):  
A. V. Solntsava ◽  
N. V. Volkava ◽  
K. A. Beliayeva ◽  
V. A. Zhurauliou
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Cyclical Cushing’S Disease

A patient with cushing's disease for pituitary tumor resection: Anesthetic challenges and management

2017 ◽  
Vol 3 (4) ◽  
pp. 79
Author(s):  
Renu Bala ◽  
Garima Vashisht ◽  
Ishwar Singh ◽  
Saquib Siddique
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Tumor ◽  
Tumor Resection ◽  
Cushing's Disease

scholarly journals Pasireotide treatment significantly reduces tumor volume in patients with Cushing’s disease: results from a Phase 3 study

Pituitary ◽  
2019 ◽  
Vol 23 (3) ◽  
pp. 203-211 ◽  
Author(s):  
André Lacroix ◽  
Feng Gu ◽  
Jochen Schopohl ◽  
Albert Kandra ◽  
Alberto M. Pedroncelli ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Tumor Size ◽  
Pituitary Tumor ◽  
Tumor Volume ◽  
Volume Reduction ◽  
Cushing's Disease ◽  
Phase 3 ◽  
Post Hoc Analysis ◽  
Tumor Volume Reduction ◽  
Post Hoc

Abstract Purpose In the multinational, randomized, double-blind, Phase 3 B2305 study of patients with Cushing’s disease (CD; ClinicalTrials.gov identifier NCT00434148), pasireotide substantially decreased urinary-free cortisol (UFC) levels, decreased mean corticotroph tumor volume, and improved clinical signs of disease. The current post hoc analysis further assesses the effects of pasireotide on corticotroph pituitary tumor volume. Methods Patients enrolled in the B2305 study had persistent or recurrent CD or newly diagnosed CD but were not surgical candidates. Enrollees were randomized to receive subcutaneous pasireotide, either 600-μg or 900-μg twice daily. Tumor volume was assessed independently at months 6 and 12 by 2 blinded radiologists and compared with baseline value and UFC response. Results Of 162 patients enrolled in the trial, 53 had measurable tumor volume data and were included in the post hoc analysis. Reductions in tumor volume were both dose and time dependent. Tumor volume reduction was more frequently observed at month 6 in the 900-μg group (75%) than in the 600-μg group (44%). Similarly, at month 12 (n = 32), tumor volume reduction was observed more frequently in the 900-µg group (89%) than in the 600-µg group (50%). Control of UFC levels was not required for reduction of tumor volume. No relationship was noted between baseline tumor size and change in tumor size. Conclusions Measurable decreases in pituitary tumor volume were observed in a large proportion of patients with CD and measurable tumor volume who were enrolled in the trial and treated with subcutaneous pasireotide; this decrease was not correlated with UFC control. ClinicalTrials.gov identifier NCT00434148.

Immunochistochemical characteristics of blood vessels in non-visualized and visualized on MRI pituitary adenoma in patients with Cushing’s disease

2016 ◽  
Vol 62 (5) ◽  
pp. 65-66
Author(s):  
Patimat M. Khandaeva ◽  
Iya A. Voronkova ◽  
Zhanna E. Belaya ◽  
Lyudmila Y. Rozhinskaya ◽  
Aleksandr V. Vorontsov ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Blood Vessels ◽  
Cushing’S Disease ◽  
Pituitary Tumor ◽  
Pituitary Tumors ◽  
Average Diameter ◽  
Cushing's Disease ◽  
Retrospective Evaluation ◽  
Acth Secreting ◽  
Microvessels Density

Backgraund. Regardless of improvements in MRI, up to 20% of ACTH-secreting pituitary tumors are only identified at surgical exploration.Aim: to estimate whether there is any difference in blood vessels and the subsequent ability to uptake contrast agent in visualized microadenoma as compared to non-visualized on MRI ACTH-secreting pituitary tumors.Materials and methods. retrospective evaluation of ACTH-positive pituitary tumors from patients with Cushing’s disease (n=39) with either non-visualized pituitary tumor on MRI (n=17) or pituitary tumor less then 25 mm (n=22). MRI was performed using Siemens Magnetom Harmony 1.0T with gadolinium. Selected tumors were stained with anty-СD34 antibody (clone QBEnd/10, RTU, Leica) and anty-D2-40 antibody (clone D2-40, RTU, Dako). We evaluated the microvessels density and measured the diameter of larger and smaller vessel.Results. The microvessels density were not different in subject with visualized (123 [77;136]) and non-visualized (112 [110,0;126,5]) pituitary adenomas as well as number of slit-shaped vessels (32 [5;50] in visualized vs 25 [5;50] in non-visualized pituitary adenoma). The diameter of these vessels also did not differ: the diameter of the largest vessels in patients without visualization 53 µm [32,5;63,5] vs 33 µm [30,0;51,5], the average diameter of the blood vessels 15 µm [14,5-26,0] against 13 µm [12;14].Conclusions. The diameter and microvessels density in ACTH-producing pituitary adenoma does not affect the visualization of adenoma on MRI in patients with Cushing 's disease.

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