Gamma knife radiosurgery is a successful adjunctive therapy in Cushing’s disease: Case report Introduction:
Pituitary tumors are benign tumors, which cause 20% of all primary brain tumors. Pituitary adenomas are categorized into two groups. The first is the secretory adenomas, which overproduce normal pituitary hormones; usually they are microadenomas, such functioning adenomas include those with Cushing’s disease (high adernocorotitrophic hormone-ACTH), Acromegaly (high growth hormone-GH) and Prolactinomas. The second are non-secretory adenomas. Cushing’s disease is an endocrine disorder, defined by excessive levels of cortisol, resulting from overproduction of adrenocorticotropic hormone by a pituitary adenoma. Although rare, it is associated with high morbidity and mortality. In order to normalize the hazardous effects of …show more content…
Expansion of pituitary adenomas cause compression of adjacent anatomical structures and sella turcica enlargement. They may diffuse into the sphenoid sinus, cavernous sinus and diaphragma sellae. Cavernous sinus invasion occurs in 6 to 10% of all pituitary adenomas. Treatment of secretory pituitary adenomas is based on surgery, fractionated radiotherapy and medication. Transsphenoidal microsurgery has remained the first line of treatment with a 77 to 85% success rate. Tumor invasion into adjacent structures and incomplete tumor resection are the most common causes of hypercortisolemia after first surgery. The first explored radiation treatment modality for persistent Cushing’s disease was fractionated radiation, with reported remission rates ranging 65 to 83%. However, it is associated with increased rate of hypopituitarism (50-100%). Overtime, stereotactic radiosurgery has been used for recurrent or refractory Cushing’s disease. From 1991 to 2007,