LINAC Radiosurgery in Recurrent Cushing's Disease after Transsphenoidal Surgery: A Series of 5 Cases

Abstract

Introduction: Oversecretion of ACTH from pituitary adenomas is associated with morbidity and reduced life expectancies. We hypothesized that radiosurgical treatment may provide effective tumour and hormonal control associated with minimal pituitary insufficiency. Method: Data of five patients who underwent LINAC radiosurgery for recurrent or residual Cushing's disease between 1999 and 2002 were prospectively collected. Result: Follow-up period ranged from 27 to 49 months (mean 38 months). All patients attained remission in 6 - 18 months (mean 8.4 months). One patients (20%) developed biochemical recurrence 12 months after remission. One patient (20%) developed hydrocortisone deficiency 24 months after radiosurgery. None of the patients had new visual field defect detected on follow-up. Conclusion: In this small case series, LINAC radiosurgery was shown to be an effective and safe treatment of persistent or recurrent Cushing's disease following transsphenoidal surgery. Long-term follow-up and larger patient series is recommended for further clarification.