Pituitary tumor type affects the chance of biochemical remission after radiosurgery of hormone-secreting pituitary adenomas

Bruce E. Pollock, Paul D. Brown, Todd B. Nippoldt, William Francis Young

Research output: Contribution to journalArticle

52 Scopus citations

Abstract

OBJECTIVE: Reported biochemical remission rates have ranged widely after stereotactic radiosurgery for patients with hormone-secreting pituitary adenomas. Confounding variables include histology, radiation dose, use of pituitary-suppressive medications, and length of follow-up. METHODS: A retrospective review of 46 patients with pituitary adenomas (growth hormone-secreting, n = 27; prolactin-secreting, n = 11; adrenocorticotropin- secreting, n = 8) undergoing radiosurgery between January 1990 and December 2003 was conducted. All received a tumor margin dose of 18 Gy or more and were off pituitary-suppressive medications for at least 1 month before radiosurgery. The groups were similar with regard to irradiated volume, radiation dose, and follow-up. The median endocrinological follow-up after radiosurgery was 54 months. RESULTS: The 4-year remission rates were 87% for patients with Cushing's disease, 67% for patients with acromegaly, and 18% for patients with prolactinomas. Patients with oversecretion of adrenocorticotropin or growth hormone were more likely to achieve remission after radiosurgery than patients with prolactinomas (hazard ratio, 4.4; 95% confidence interval, 1.1-18.2; P = 0.04). Of 44 patients with normal or partial anterior pituitary function before radiosurgery, 16 (36%) developed one or more new anterior pituitary deficits. The incidence of new anterior pituitary deficits was 26% at 4 years. No differences were noted in the incidence of new anterior deficits among the groups. CONCLUSION: There seems to be a differential sensitivity after radiosurgery for hormone-secreting pituitary adenomas. Remission rates are greater for patients with Cushing's disease and acromegaly, whereas radiosurgery is less effective in achieving biochemical remission for patients with prolactinomas.

Original languageEnglish (US)
Pages (from-to)1271-1276
Number of pages6
JournalNeurosurgery
Volume62
Issue number6
DOIs
StatePublished - Jun 2008

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Keywords

  • Acromegaly
  • Cushing's disease
  • Pituitary adenoma
  • Prolactinoma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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