Endocrine Abstracts (2006) 11 P455

Hypocorticism after radiosurgery (protonotherapy) in patients with normal MRI and in patients with confirmed tumor for Cushing’s disease

OV Manchenko & EI Marova


Departament of Neuroradiology, National Research Center for Endocrinology Russian Academy of Medical Science, Moscow, Russia.


In some patients with Cushing’s disease (CD), magnetic resonance imaging (MRI) fails to detect small pituitary ACTH-secreting adenomas despite the results of endocrine evaluation indicating Cushing’s disease.

Aim: The aim of this paper is to study frequency of hypocorticism after radiosurgery – protonotherapy (PT) for patients with normal MRI for Cushing’s disease and for patients with confirmed adenomas.

Methods: Between 1997 and 2002, 125 patients with CD underwent PT at our institution: 59 patients with normal MRI (group 1) and 66 patients with confirmed adenomas (group 2). Their results were analyzed retrospectively.

Results: Clinical improve occurred in 88.6% pat. of group 1 and in 95.9% pat. of group 2; complete hormonal remission was achieved in 81.1% patients with normal MRI and in 70% pat. with confirmed adenomas. Recurrence after PT was documented only in two patients of group 2. Radiologically-induced hypocorticism have occurred in 20.3% (12/59) pat. of group 1 and in 12.3% (8/66) pat. of group 2 (P=0.33). These data is comparable with results of selective adenomectomy.

Conclusion: PT can be performed for Cushing’s disease with normal MRI. Patients with no histological confirmation of tumor after PT for CD are likely to have a good outcome. The results do not differ significantly from reported hypocorticism rates in patients with confirmed adenomas.

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