Author:
Lamberts S. W. J.,de Jong F. H.,Birkenhäger J. C.
Abstract
ABSTRACT
Eighteen unselected patients with Cushing's disease were treated by unilateral adrenalectomy followed by conventional external pituitary irradiation (4500 rads). In 9 of these patients (50 %) a remission has been reached as judged by the clinical picture and the cortisol secretion rate (CSR) up to an average of 5 years after operation (follow-up varying between 1 and 7.5 years). The 9 other patients showed a relapse making necessary a second adrenalectomy after an average of 15 months (5 to 57 months). Four of these patients had a slightly enlarged (two cases) or asymmetrical sella turcica (two cases).
The gain of this therapeutic regimen was that no permanent adrenal insufficiency is induced in 50 % of the patients, that no pituitary tumours developed and that no loss of pituitary function occurred. Before treatment the group of 9 patients, who did not improve or relapsed after treatment, showed a greater rise of plasma cortisol in response to lysine vasopressin, a (greater) decrease of plasma cortisol in response to a single oral dose of 1 mg dexamethasone and an earlier decrease of the urinary 17-OGS in response to 2 mg dexamethasone four times daily orally. It is concluded that in the patients whose hypothalamo-pituitary-adrenal axis could be manipulated less this therapeutic regimen had a better result.
Subject
Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism
Cited by
17 articles.
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