BACKGROUND Corticotroph adenoma delineation in Cushing's disease (CD) patients with previous surgery can be challenging. This study investigated the outcome of wholesellar Gamma Knife Radiosurgery (GKRS) in MRI-negative, but hormone-active… Click to show full abstract
BACKGROUND Corticotroph adenoma delineation in Cushing's disease (CD) patients with previous surgery can be challenging. This study investigated the outcome of wholesellar Gamma Knife Radiosurgery (GKRS) in MRI-negative, but hormone-active CD patients with prior failed treatment attempts. METHODS We retrospectively analyzed data of nine CD cases who underwent wholesellar GKRS between April 2008 and April 2020 at a single center. Remission was determined as normal morning serum cortisol, normal 24-hour urinary free cortisol (UFC), or extended postoperative requirement for hydrocortisone replacement. RESULTS Median age was 35.0 years, and most of the cases were female (89%). All subjects had undergone previous surgery. The mean pre-GKRS morning serum cortisol and 24-hour UFC was 27.5 mcg/dL and 408.0 mcg, respectively. Target volume varied from 0.6 to 1.8 cc, and the median margin dose was 28 Gy. The median duration of endocrine follow-up was 105 months, and initial endocrine remission was achieved in eight subjects (89%) at a median time of 22 months. The actuarial initial remission was 44% at two years, 67% at four years, and 89% at six years. The mean recurrence-free survival was 128 months. Age and pre-GKRS morning serum cortisol were found to be predictors for initial and durable endocrine remissions. New-onset hypopituitarism was observed in two of five patients (40%). None of the patients developed new neurological deficits and had GKRS-related adverse events during the follow-up. CONCLUSIONS Whole-sellar GKRS is a safe and efficient method to manage MRInegative CD and provides similar GKRS outcome rates as in MRI-positive CD.
               
Click one of the above tabs to view related content.