Gamma Knife Radiosurgery for Cushing's Disease in Patients with a Normal Magnetic Resonance Imaging Scan |
Se-Hwan Kim, Jung-Il Lee, Sung-Tae Kim, Myung-Sik Lee, Moon-Kyu Lee, Kwang-Won Kim, Jong-Hyun Kim |
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDepartment of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDivision of Endocrinology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea |
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Abstract |
Purpose : This study was performed to evaluate the effectiveness and safety of gamma knife radiosurgery (GKRS) for Cushing's disease (CD) in patients with a normal magnetic resonance imaging (MRI) scan.
Methods : This study involved 4 patients (1 man and 3 women ; 14-64 years old). All patients revealed clinical stigmata of CD at history taking and physical examination. MRI performed in all patients and images of all four cases were considered normal. Biochemical assays included basal plasma ACTH and serum cortisol concentrations, 24hr urine free cortisol excretion (UFC), low- and high-dose dexamethasone suppression test (LDDST and HDDST), and bilateral inferior petrosal sinus sampling with corticotropin stimulation. They underwent GKRS as the first-line treatment to avoid risk of surgical exploration. The prescribed marginal dose was 30Gy at the 50% isodose.
Results : In all patients clinical symptom and sign began to improve within a few weeks after GKRS. Serum cortisol, 24hr UFC, LDDST and HDDST confirmed remission in 4 patients within 6 months after GKRS. However, one patient failed to acquire long term remission. After 41months from GKRS, she underwent right hemihypophysectomy. Complications of GKRS did not occur in any patient.
Conclusions : We suggest GKRS to be considered as an alternative modality of surgical exploration in the patients with pituitary origin of ACTH hypersecretion and normal MRI findings. |
Key Words:
Cushing disease, ACTH hypersecretion, Pituitary, Gamma knife radiosurgery, Stereotactic radiosurgery. |
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