Open AccessGamma Knife radiosurgery: effect on corticotropin-secreting pituitary adenoma
Author(s) -
Dan Nicolae Păduraru,
Raluca Ciunt,
Andra Morar,
Laura Dragomir,
Carla Scânteie,
Alexandra Bolocan,
Octavian Andronic,
Cristina Ghervan,
Bogdan Socea,
Mara Cârșote,
Ana Valea
Publication year - 2019
Publication title -
romanian neurosurgery
Language(s) - English
Resource type - Journals
eISSN - 2344-4959
pISSN - 1220-8841
DOI - 10.33962/roneuro-2019-065
Subject(s) - medicine , radiosurgery , pituitary adenoma , hirsutism , cushing's disease , adrenocorticotropic hormone , surgery , adenoma , gastroenterology , hormone , disease , endocrinology , diabetes mellitus , radiation therapy , insulin resistance , polycystic ovary
Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures.
Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant.
Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse.