Endocrine Abstracts (2011) 26 P36

Radiosurgery with application of protone beam in patients with Cushing's disease: a hormonal monitoring of the long-term results

E Marova, N Goncharov, G Kolesnikova, S Arapova, M Zhimirikina & O Manchenko


National Research Centre of Endocrinology, Moscow, Russian Federation.


Patients with Cushing’s disease were treated with proton beam surgery (pituitary irradiation) and the long-term results were studied. Hormone levels in 197 patients with the verified Cushing’s disease (161 woman and 36 men) were monitored after proton irradiation. Age of patients before irradiation is 17–54 years. Duration of supervision is 1–24 years.

In peripheral blood, the concentration of pituitary hormones (ACTH, prolactin, LH, FSH, TSH, GH), and hormones of peripheral glands (cortisol, estradiol, testosterone, free thyroxine) and free cortisol in daily urine were measured. ACTH and cortisol were measured at 0800 and 2300 h in order to follow the daily dynamics of their secretion.

Full remission of the basic disease as judged by the hormonal parameters was found in 83.6% (1.5±1.8 years after the therapy). Remission without the subsequent decrease of pituitary functions was observed in 21.8%. Multiple side effects of irradiation were observed in 50.1%, whereas single side effects were registered in 27.4%. The main side effects were: adrenal insufficiency – 29.7%, secondary hypothyroidism – 33.8%, hypogonadism – 47.4%, hyperprolactinemia – 36.7%.

We conclude that the fist side effect to appear is adrenal insufficiency (2.5±2.3 years), then increase of prolactin and decrease of gonadotropins (consecutively, 3.0±2.9 and 3.0±3.1 years). The last side effect to appear is secondary hypothyroidism (5.0±3.2 years).

Biochemical hormonal monitoring is essential requirement of the dynamic follow-up of patients with Cushing’s disease during lifelong period of time for timely revealing of hypopituitarism and appointments of corresponding therapy.

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