Pituitary Irradiation by Gamma Knife in Intractable Cancer Pain

OBJECTIVE: Cancer pain has been treated by gamma knife radiosurgery(GKS), targeted to the pituitary gland-stalk, as an alternative new pain control method. The purpose of this study is to prove the efficacy and the safety of this treatment. METHODS: Seven patients with intractable cancer pain underwent pituitary gland-stalk irradiation by gamma knife. Selections for patient inclusion in this treatment protocol were no other effective pain treatment options, general condition rated as greater than 40 on Karnofsky Performance Scale, and pain relief by morphine though not satisfactory. The target was the junction between the pituitary stalk and the neurohypophysis. The maximum dose was 150~160Gy with one isocenter in 8mm collimator or two isocenters in 4mm collimator keeping the radiation dose to the optic nerve less than 8Gy. RESULTS: In all seven cases, the significant pain reduction was obtained during immediate post-GKS period without serious complications except one patient who developed transient hypopituitarism and diabetes insipidus. Pain relief was observed within several days, and this effect was prolonged for a quite long time. At a follow up of 1.5 to 13 months, pain recurred in two patients and no hormonal and visual dysfunctions were observed. CONCLUSION: Despite insufficient experience, the efficacy and the safety of GKS for intractable cancer pain were demonstrated in seven patients. This treatment has the potential to ameliorate cancer pain, and GKS will play a more important role in the treatment of intractable pain.

A Case of Cughing's Disease which Responded to the Combined Treatment of Ketoconazole and Octreotide / 대한내분비학회지

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.

Tumores de hipófisis: presentación clínica y evaluación del tratamiento por cirugía transfenoidal / Pituitary tumors: clinical presentation and assesment of transphenoidal surgical treatment

The clinical manifestations and the surgical treatment results of 280 patients (179 female), undergoing a total of 319 operations at the Asenjo Institute of Neurosurgery were retrospectively analyzed. The surgical approach for the first operation was transphenoidal in 89.3 per cent of patients and transcraneal in the rest. Tumors were non secretory in 169 (60.4 per cent)patients, prolactinomas in 75 (27.8 per cent) and produced acromegalia in 29 (10.4 per cent) and Cushing syndrome in 7 (2.5 per cent) patients. There was extraselar extension in 42 per cent of women and 71 per cent of men. The surgical treatment of prolactinomas corrected endocrine alterations in 25 of 29 and visual alterations in 18 of 27 patients assessed. Surgical treatment of acromegalia improved endocrine alterations in 11 of 13 and visual alterations in 4 of 10 patients assessed. Treatment of non secretory tumors corrected visual alterations in 38 of 64 patients assessed. The principal complication of transphenoidal surgery was transient diabetes insipidus in 6.8 per cent of patients. Overall mortality was 2.3 per cent for transphenoidal surgery and 5.6 per cent for transcraneal surgery. It is concluded that transphenoidal surgery is effective for the management extraselar complications of pituitary tumors and endocrine management of selected cases

Acromegalia, fisiopatología y clínica / Acromegaly, physiopathology and clinics

La acromegalia es comúnmente un cuadro de curso lento y progresivo que afecta los órganos y tejidos, determinando gran morbilidad y aumento de la mortalidad. Existen en la actualidad tratamientos quirúrgicos y radioterápicos satisfactorios y perspectivas en el futuro próximo de tratamientos médicos adecuados mediante agonistas de la somatostatina de acción prolongada. Los pacientes deben ser referidos para tratamiento en los centros especializados, aún cuando presenten un cuadro clínico aparentemente benigno

Irradiaçäo hipofisária como tratamento inicial na doença de cushing / Hypophyseal irradiation with initial treatment of cushing's disease

Neste relato sao descritos os casos de duas mulheres com diagnóstico de doença de Cushing, que foram tratadas inicialmente com radioterapia externa hipofisária na dose de 45 Gy, obtendo-se resultado favorável. As pacientes apresentaram regressao clínica e laboratórial da doença, com posterior gravidez em ambas, aos 21 e 30 meses pós-radioterapia. É apresentada uma revisao da literatura a respeito das condutas cirúrgica e radioterápica na doença de Cushing, ressaltando-se seus efeitos deletérios especialmente sobre a funçao residual da hipófise anterior. (Arq Bras Endocrinol Metab 1994;38/1:43-46).