Gamma Knife radiosurgery: effect on corticotropin-secreting pituitary adenoma

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Dan Nicolae Paduraru
Raluca Ciunt
Andra Morar
Laura Maria Dragomir
Carla Scânteie
Alexandra Bolocan
Octavian Andronic
Cristina Ghervan
Bogdan Socea
Mara Carsote
Ana Valea

Abstract

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures.


Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant.


Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse.

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How to Cite
Paduraru, D., Ciunt, R., Morar, A., Dragomir, L., Scânteie, C., Bolocan, A., Andronic, O., Ghervan, C., Socea, B., Carsote, M., & Valea, A. (2019). Gamma Knife radiosurgery: effect on corticotropin-secreting pituitary adenoma. Romanian Neurosurgery, 33(4), 400-403. https://doi.org/10.33962/roneuro-2019-065
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Author Biographies

Dan Nicolae Paduraru

1.  General Surgery Department and Emergency III, University Emergency Hospital of Bucharest, Romania

2.  Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Raluca Ciunt

Endocrinology Department, County Clinical Emergency Hospital, Cluj-Napoca, Romania

Andra Morar

Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania

Laura Maria Dragomir

Endocrinology Department, County Clinical Emergency Hospital, Cluj-Napoca, Romania

Carla Scânteie

Endocrinology Department, County Clinical Emergency Hospital, Cluj-Napoca, Romania

Alexandra Bolocan

1. General Surgery Department and Emergency III, University Emergency Hospital of Bucharest, Romania

2. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Octavian Andronic

1. General Surgery Department and Emergency III, University Emergency Hospital of Bucharest, Romania

2. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Cristina Ghervan

1. Endocrinology Department, County Clinical Emergency Hospital, Cluj-Napoca, Romania

2. Iuliu Hatieganu University of Medicine and Pharmacy & County Clinical Hospital, Cluj-Napoca, Romania

Bogdan Socea

1. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

2. Clinical Emergency Hospital “Sf. Pantelimon”, Bucharest, Romania 

Mara Carsote

C.I. Parhon National Institute of Endocrinology, Bucharest, Romania

Ana Valea

1. Endocrinology Department, County Clinical Emergency Hospital, Cluj-Napoca, Romania

2. Iuliu Hatieganu University of Medicine and Pharmacy & County Clinical Hospital, Cluj-Napoca, Romania