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CLINICAL STUDY |
1 Department of Neurosurgery, 2 Section for Endocrinology, Department of Medicine,3 Department of Ophthalmology,4 Centre for Clinical Research and Haukeland University Hospital, Bergen, Norway, 5 Institute of Surgery 6 Institute of Medicine, 7 Department of Clinical Medicine and 8 Department of Biomedicine, University of Bergen, Bergen, Norway and 9 Department of Endocrinology, Internal Medicine, Norwegian National Hospital, Oslo, Norway
(Correspondence should be addressed to E O Vik-Mo who is now at Department of Neurosurgery, Ulleval University Hospital, Oslo, Norway and Vilhelm Magnus Center for Neurosurgical Research, Institute for Surgical Research, Norwegian National Hospital, Oslo, Norway; Email: e.o.vik-mo{at}medisin.uio.no)
Background: Gamma knife radiosurgery (GKR) is an adjuvant treatment for acromegaly if surgery fails to normalize GH hypersecretion.
Objective: To examine the effect of GKR on tumor growth and hypersecretion, and to characterize the adverse effect of this treatment.
Design: Cross-sectional follow-up study. First, retrospective data pre- and post-GKR were collected. Patients then underwent a predefined survey including radiological, endocrinological, ophthalmological, and neurosurgical evaluation.
Setting: Norwegian National Center for gamma knife treatment.
Patients: Sixty-one patients treated with GKR for acromegaly. Out of 55, 53 living patients underwent a detailed survey. The mean follow-up was 5.5 years. No patient was lost to follow-up.
Results: Tumor growth was stopped in all patients. At 3, 5, and 10 years after GKR, 45, 58, and 86% of patients had normal IGF-I levels. Consecutive hormone value analysis showed that patients receiving GH-suppressive medication had a more rapid decline in hypersecretion than those who did not receive such medication. Evaluated by survey baseline values alone, non-elevated IGF-I and GH levels below 5 mIU/l were found in 38%. GH-suppressive medication was terminated in 16 out of 40 patients following GKR. Nine out of 53 surveyed patients (17%) had normal IGF-I and GH nadir below 2.6 mIU/l at glucose tolerance tests, while not on hormone-suppressive medication. Two patients developed minor visual field defects. Eight patients started hormone substitution therapy during the follow-up period.
Conclusion: GKR is an effective adjuvant treatment for residual acromegaly, carrying few side effects.
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  C L Ronchi, C Giavoli, E Ferrante, E Verrua, S Bergamaschi, D I Ferrari, S Corbetta, L Montefusco, M Arosio, B Ambrosi, et al. Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments Eur. J. Endocrinol., July 1, 2009; 161(1): 37 - 42. [Abstract] [Full Text] [PDF]
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 S. Melmed, A. Colao, A. Barkan, M. Molitch, A. B. Grossman, D. Kleinberg, D. Clemmons, P. Chanson, E. Laws, J. Schlechte, et al. Guidelines for Acromegaly Management: An Update J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1509 - 1517. [Abstract] [Full Text] [PDF]
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E. O. Vik-Mo, M. Oksnes, P.-H. Pedersen, T. Wentzel-Larsen, E. Rodahl, F. Thorsen, T. Schreiner, S. Aanderud, and M. Lund-Johansen Gamma knife stereotactic radiosurgery of Nelson syndrome Eur. J. Endocrinol., February 1, 2009; 160(2): 143 - 148. [Abstract] [Full Text] [PDF]
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M. Losa, L. Gioia, P. Picozzi, A. Franzin, M. Valle, M. Giovanelli, and P. Mortini The Role of Stereotactic Radiotherapy in Patients with Growth Hormone-Secreting Pituitary Adenoma J. Clin. Endocrinol. Metab., July 1, 2008; 93(7): 2546 - 2552. [Abstract] [Full Text] [PDF]
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