Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: Factors associated with endocrine normalization

Bruce E. Pollock, Todd B. Nippoldt, Scott L. Stafford, Robert L. Foote, Charles F. Abboud

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

Object. The goal of this study was to determine factors associated with endocrine normalization after radiosurgery is performed in patients with hormone-producing pituitary adenomas. Methods. Between 1990 and 1999, 43 patients with hormone-producing pituitary adenomas underwent radiosurgery: 26 patients with growth hormone (GH)-producing tumors, nine with adrenocorticotrophic hormone-producing tumors, seven with tumors that produced prolactin (PRL) alone, and one with a tumor that secreted both GH and PRL. The median patient age was 42 years. Thirty-seven patients (86%) had undergone surgery earlier and in 30 (70%) there was tumor extension into the cavernous sinus. The product-limit method was used to calculate endocrine normalization while patients were not receiving any hormone-suppressive medication. The median follow-up period after radio-surgery was 36 months (range 12-108 months). In 20 patients (47%) there was normalization of hormone secretion at a median of 14 months (range 2-44 months) after radiosurgery; no correlation was found between tumor type and cure. Actuarial cure rates were 20, 32, and 61% at 1, 2, and 4 years posttreatment. Multivariate analysis demonstrated that the absence of hormone-suppressive medications at the time of radiosurgery (relative risk 8.9, 95% confidence interval [CI] 1.2-68.7, p = 0.04) and maximum radiation doses greater than 40 Gy (relative risk 3.9, 95% CI 1.3-11.7, p = 0.02) correlated with an endocrine cure. A new anterior pituitary deficiency developed in seven patients (16%), temporal lobe necrosis was identified in two patients, an asymptomatic internal carotid artery stenosis was detected in two patients, and unilateral blindness occurred in one patient. Conclusions. Radiosurgery provides an endocrine cure for many patients with persistent or recurrent hormone-producing pituitary adenomas. Further study is needed to determine whether pituitary hormone-suppressive medications have a radioprotective effect.

Original languageEnglish (US)
Pages (from-to)525-530
Number of pages6
JournalJournal of Neurosurgery
Volume97
Issue number3
StatePublished - Sep 2002

Fingerprint

Radiosurgery
Pituitary Neoplasms
Hormones
Neoplasms
Prolactin
Growth Hormone
Confidence Intervals
Cavernous Sinus
Pituitary Hormones
Carotid Stenosis
Kaplan-Meier Estimate
Temporal Lobe
Blindness
Radio
Adrenocorticotropic Hormone
Necrosis
Multivariate Analysis
Radiation

Keywords

  • Acromegaly
  • Cushing disease
  • Pituitary adenoma
  • Prolactin
  • Radiosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Pollock, B. E., Nippoldt, T. B., Stafford, S. L., Foote, R. L., & Abboud, C. F. (2002). Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: Factors associated with endocrine normalization. Journal of Neurosurgery, 97(3), 525-530.

Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas : Factors associated with endocrine normalization. / Pollock, Bruce E.; Nippoldt, Todd B.; Stafford, Scott L.; Foote, Robert L.; Abboud, Charles F.

In: Journal of Neurosurgery, Vol. 97, No. 3, 09.2002, p. 525-530.

Research output: Contribution to journalArticle

Pollock, Bruce E. ; Nippoldt, Todd B. ; Stafford, Scott L. ; Foote, Robert L. ; Abboud, Charles F. / Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas : Factors associated with endocrine normalization. In: Journal of Neurosurgery. 2002 ; Vol. 97, No. 3. pp. 525-530.
@article{2f069616899b4d03bb117bb7877350ec,
title = "Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: Factors associated with endocrine normalization",
abstract = "Object. The goal of this study was to determine factors associated with endocrine normalization after radiosurgery is performed in patients with hormone-producing pituitary adenomas. Methods. Between 1990 and 1999, 43 patients with hormone-producing pituitary adenomas underwent radiosurgery: 26 patients with growth hormone (GH)-producing tumors, nine with adrenocorticotrophic hormone-producing tumors, seven with tumors that produced prolactin (PRL) alone, and one with a tumor that secreted both GH and PRL. The median patient age was 42 years. Thirty-seven patients (86{\%}) had undergone surgery earlier and in 30 (70{\%}) there was tumor extension into the cavernous sinus. The product-limit method was used to calculate endocrine normalization while patients were not receiving any hormone-suppressive medication. The median follow-up period after radio-surgery was 36 months (range 12-108 months). In 20 patients (47{\%}) there was normalization of hormone secretion at a median of 14 months (range 2-44 months) after radiosurgery; no correlation was found between tumor type and cure. Actuarial cure rates were 20, 32, and 61{\%} at 1, 2, and 4 years posttreatment. Multivariate analysis demonstrated that the absence of hormone-suppressive medications at the time of radiosurgery (relative risk 8.9, 95{\%} confidence interval [CI] 1.2-68.7, p = 0.04) and maximum radiation doses greater than 40 Gy (relative risk 3.9, 95{\%} CI 1.3-11.7, p = 0.02) correlated with an endocrine cure. A new anterior pituitary deficiency developed in seven patients (16{\%}), temporal lobe necrosis was identified in two patients, an asymptomatic internal carotid artery stenosis was detected in two patients, and unilateral blindness occurred in one patient. Conclusions. Radiosurgery provides an endocrine cure for many patients with persistent or recurrent hormone-producing pituitary adenomas. Further study is needed to determine whether pituitary hormone-suppressive medications have a radioprotective effect.",
keywords = "Acromegaly, Cushing disease, Pituitary adenoma, Prolactin, Radiosurgery",
author = "Pollock, {Bruce E.} and Nippoldt, {Todd B.} and Stafford, {Scott L.} and Foote, {Robert L.} and Abboud, {Charles F.}",
year = "2002",
month = "9",
language = "English (US)",
volume = "97",
pages = "525--530",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "3",

}

TY - JOUR

T1 - Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas

T2 - Factors associated with endocrine normalization

AU - Pollock, Bruce E.

AU - Nippoldt, Todd B.

AU - Stafford, Scott L.

AU - Foote, Robert L.

AU - Abboud, Charles F.

PY - 2002/9

Y1 - 2002/9

N2 - Object. The goal of this study was to determine factors associated with endocrine normalization after radiosurgery is performed in patients with hormone-producing pituitary adenomas. Methods. Between 1990 and 1999, 43 patients with hormone-producing pituitary adenomas underwent radiosurgery: 26 patients with growth hormone (GH)-producing tumors, nine with adrenocorticotrophic hormone-producing tumors, seven with tumors that produced prolactin (PRL) alone, and one with a tumor that secreted both GH and PRL. The median patient age was 42 years. Thirty-seven patients (86%) had undergone surgery earlier and in 30 (70%) there was tumor extension into the cavernous sinus. The product-limit method was used to calculate endocrine normalization while patients were not receiving any hormone-suppressive medication. The median follow-up period after radio-surgery was 36 months (range 12-108 months). In 20 patients (47%) there was normalization of hormone secretion at a median of 14 months (range 2-44 months) after radiosurgery; no correlation was found between tumor type and cure. Actuarial cure rates were 20, 32, and 61% at 1, 2, and 4 years posttreatment. Multivariate analysis demonstrated that the absence of hormone-suppressive medications at the time of radiosurgery (relative risk 8.9, 95% confidence interval [CI] 1.2-68.7, p = 0.04) and maximum radiation doses greater than 40 Gy (relative risk 3.9, 95% CI 1.3-11.7, p = 0.02) correlated with an endocrine cure. A new anterior pituitary deficiency developed in seven patients (16%), temporal lobe necrosis was identified in two patients, an asymptomatic internal carotid artery stenosis was detected in two patients, and unilateral blindness occurred in one patient. Conclusions. Radiosurgery provides an endocrine cure for many patients with persistent or recurrent hormone-producing pituitary adenomas. Further study is needed to determine whether pituitary hormone-suppressive medications have a radioprotective effect.

AB - Object. The goal of this study was to determine factors associated with endocrine normalization after radiosurgery is performed in patients with hormone-producing pituitary adenomas. Methods. Between 1990 and 1999, 43 patients with hormone-producing pituitary adenomas underwent radiosurgery: 26 patients with growth hormone (GH)-producing tumors, nine with adrenocorticotrophic hormone-producing tumors, seven with tumors that produced prolactin (PRL) alone, and one with a tumor that secreted both GH and PRL. The median patient age was 42 years. Thirty-seven patients (86%) had undergone surgery earlier and in 30 (70%) there was tumor extension into the cavernous sinus. The product-limit method was used to calculate endocrine normalization while patients were not receiving any hormone-suppressive medication. The median follow-up period after radio-surgery was 36 months (range 12-108 months). In 20 patients (47%) there was normalization of hormone secretion at a median of 14 months (range 2-44 months) after radiosurgery; no correlation was found between tumor type and cure. Actuarial cure rates were 20, 32, and 61% at 1, 2, and 4 years posttreatment. Multivariate analysis demonstrated that the absence of hormone-suppressive medications at the time of radiosurgery (relative risk 8.9, 95% confidence interval [CI] 1.2-68.7, p = 0.04) and maximum radiation doses greater than 40 Gy (relative risk 3.9, 95% CI 1.3-11.7, p = 0.02) correlated with an endocrine cure. A new anterior pituitary deficiency developed in seven patients (16%), temporal lobe necrosis was identified in two patients, an asymptomatic internal carotid artery stenosis was detected in two patients, and unilateral blindness occurred in one patient. Conclusions. Radiosurgery provides an endocrine cure for many patients with persistent or recurrent hormone-producing pituitary adenomas. Further study is needed to determine whether pituitary hormone-suppressive medications have a radioprotective effect.

KW - Acromegaly

KW - Cushing disease

KW - Pituitary adenoma

KW - Prolactin

KW - Radiosurgery

UR - http://www.scopus.com/inward/record.url?scp=0036714594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036714594&partnerID=8YFLogxK

M3 - Article

C2 - 12296634

AN - SCOPUS:0036714594

VL - 97

SP - 525

EP - 530

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 3

ER -