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Related Concept Videos

Cushing Syndrome II: Pathophysiology01:19

Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
Cushing Syndrome I: Introduction01:26

Cushing Syndrome I: Introduction

Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...

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Related Experiment Video

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A Novel Method: Super-selective Adrenal Venous Sampling
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Published on: September 15, 2017

Gamma Knife surgery for Cushing's disease.

Jay Jagannathan1, Jason P Sheehan, Nader Pouratian

  • 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908-00212, USA.

Journal of Neurosurgery
|June 15, 2007
PubMed
Summary

Gamma Knife surgery (GKS) effectively treats Cushing's disease in 54% of patients. This radiosurgery is a valuable option for persistent pituitary adenomas, especially those not suitable for resection.

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Area of Science:

  • Neurosurgery
  • Endocrinology
  • Radiation Oncology

Background:

  • Cushing's disease, caused by adrenocorticotropic hormone-secreting pituitary adenomas, often requires multimodal treatment.
  • Pituitary adenoma resection may not achieve remission, necessitating alternative therapies.
  • Gamma Knife surgery (GKS) offers a minimally invasive approach for pituitary tumors.

Purpose of the Study:

  • To evaluate the efficacy and safety of Gamma Knife surgery (GKS) for adrenocorticotropic hormone-secreting pituitary adenomas.
  • To assess endocrine outcomes, tumor response, and adverse events following GKS.
  • To determine the role of GKS in managing persistent or recurrent Cushing's disease.

Main Methods:

  • A prospective database review of 90 patients with Cushing's disease treated with GKS between 1990 and 2005.
  • Assessment of 24-hour urinary free cortisol (UFC) levels at a minimum of 1 year post-treatment.
  • Evaluation of tumor volume changes, new hormone deficiencies, visual/cranial nerve deficits, and radiation-induced changes on MRI.

Main Results:

  • Successful endocrine remission (normal UFC) was achieved in 54% of patients at a mean of 13 months post-GKS.
  • Tumor volume decreased in 80% of visible adenomas.
  • New hormone deficiencies occurred in 22% of patients; cranial nerve deficits were observed in 10%.

Conclusions:

  • Gamma Knife surgery is an effective treatment for persistent Cushing's disease, particularly for adenomas with cavernous sinus invasion.
  • Combining microsurgical resection with GKS is a valuable strategy for managing pituitary adenomas.
  • Repeat GKS may increase the risk of cranial nerve damage.