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Albano L, Losa M, Garbin E, Pompeo E, Barzaghi LR, Mortini P. Efficacy and safety of radiosurgery in acromegaly. Best Pract Res Clin Endocrinol Metab 2024:101898. [PMID: 38806304 DOI: 10.1016/j.beem.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Stereotactic radiosurgery (SRS) more and more frequently plays a crucial role in the treatment of acromegaly. We provide a systematic review of the literature and meta-analysis, according to PRISMA, on SRS for the management of growth hormone (GH)-secreting pituitary adenomas, including several radiosurgical techniques, with the aim of describing efficacy and safety of this treatment. A weighted random effects model was used to calculate pooled outcome estimates. From 346 abstract reviews, 27 retrospective studies were included. Despite the variability in hormonal remission criteria and the heterogeneity between treatment guidelines among included studies, most of them reported an endocrine remission rate between 40% and 60%. Random effects meta-analysis for overall endocrine remission and 5-year probability of remission estimate after SRS were 46% (95% CI: 39-53%) and of 48% (95% CI: 38-57%), respectively. Random effects meta-analysis for new hypopituitarism estimate after SRS was 23% (95% CI: 17-29%). Furthermore, incidence of radiation induced optic neuropathy after SRS ranged between 0% and 6% This meta-analysis confirms and quantifies safety and effectiveness of SRS to achieve endocrine remission after surgical management in acromegaly.
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Affiliation(s)
- Luigi Albano
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
| | - Marco Losa
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Garbin
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Edoardo Pompeo
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
| | - Lina Raffaella Barzaghi
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy
| | - Pietro Mortini
- Neurosurgery and Gamma Knife Radiosurgery Unit, I.R.C.C.S. Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Bouter J, Reznik Y, Thariat J. Effects on the Hypothalamo-Pituitary Axis in Patients with CNS or Head and Neck Tumors following Radiotherapy. Cancers (Basel) 2023; 15:3820. [PMID: 37568636 PMCID: PMC10417001 DOI: 10.3390/cancers15153820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Knowledge about the precise effects of radiotherapy on hypothalamo-pituitary functions is limited. Reduction of side effects is a major goal of advanced radiotherapy modalities. We assessed strategies for monitoring and replacement of hormone deficiencies in irradiated patients. METHODS A search strategy was systematically conducted on PubMed®. Additional articles were retrieved to describe endocrine mechanisms. RESULTS 45 studies were evaluated from 2000 to 2022. They were predominantly retrospective and highly heterogeneous concerning patient numbers, tumor types, radiotherapy technique and follow-up. Endocrine deficiencies occurred in about 40% of patients within a median follow-up of 5.6 years without a clear difference between radiotherapy modalities. Somatotropic and thyrotropic axes were, respectively, the most and least radiosensitive. CONCLUSIONS Current pituitary gland dose constraints may underestimate radiation-induced endocrine deficiencies, thus impairing quality of life. Little difference might be expected between radiation techniques for PG tumors. For non-PG tumors, dose constraints should be applied more systematically.
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Affiliation(s)
- Jordan Bouter
- Radiotherapy Department, Centre François Baclesse, Avenue du Général Harris, 14000 Caen, France;
| | - Yves Reznik
- Department of Endocrinology, University Hospital of Caen, Avenue de la Côte de Nacre, 14033 Caen, France;
| | - Juliette Thariat
- Radiotherapy Department, Centre François Baclesse, Avenue du Général Harris, 14000 Caen, France;
- Corpuscular Physics Laboratory, ENSICAEN, Boulevard Maréchal Juin, 14050 Caen, France
- Unicaen—Normandie Université, 14050 Caen, France
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Martins AF, Santos M, Rosário F. Caloric restriction as a possible pitfall for persistent acromegaly follow-up - case report. BMC Endocr Disord 2023; 23:68. [PMID: 36973824 PMCID: PMC10041756 DOI: 10.1186/s12902-023-01319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Acromegaly diagnosis is established when plasma levels of IGF-1 are increased and the Oral Glucose Tolerance Test (OGTT) with 75gr of glucose can't suppress Growth Hormone (GH) levels. These two parameters are also useful during follow-up, after surgical/radiologic therapy and/or during medical therapy. CASE PRESENTATION A 29-year-old woman was diagnosed with acromegaly after a severe headache. Previous amenorrhea and facial and acral changes were noticed. A pituitary macroadenoma was found, biochemical evaluation was in agreement with the suspected acromegaly and a transsphenoidal adenectomy was performed. As the disease recurred, a surgical reintervention and radiosurgery (Gamma Knife, 22 Gy) were necessary. No normalization of IGF-1 was achieved during three years after radiosurgery. Surprisingly, then, and although clinical features seemed getting worse, IGF-1 levels became consistently controlled to 0.3-0.8 times the upper limit of the reference range. Questioned, the patient referred that she was following an intermittent fasting dietary plan. However, based on the dietary questionnaire, she was found to be under severe caloric restriction. First OGTT (under caloric restriction) showed absence of GH suppression and an IGF-1 value of 234 ng/dL (Reference Range 76-286 ng/mL). A second OGTT, one month after an eucaloric diet was instituted, showed an increased IGF-1 of 294 ng/dL, maintaining an unsuppressed, yet less elevated, GH. CONCLUSIONS GHRH/GH/IGF-1 axis controls somatic growth. Regulation is complex, and nutrition status and feeding pattern have a recognized role. Like systemic inflammation or chronic liver disease, fasting and malnutrition decrease the expression of hepatic GH receptors, with consequent reduction of IGF-1 levels, through resistance to GH. This clinical report shows that caloric restriction may represent a pitfall in acromegaly follow-up.
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Affiliation(s)
- Ana Filipa Martins
- Endocrine Department, Hospital da Luz de Lisboa, Av Lusíada, Nr 100, 1500-650 Lisbon, Portugal
| | - Mónica Santos
- Nutrition Department, Hospital da Luz de Lisboa, Av Lusíada, Nr 100, 1500-650 Lisbon, Portugal
| | - Francisco Rosário
- Endocrine Department, Hospital da Luz de Lisboa, Av Lusíada, Nr 100, 1500-650 Lisbon, Portugal
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Albano L, Losa M, Barzaghi LR, Niranjan A, Siddiqui Z, Flickinger JC, Lunsford LD, Mortini P. Gamma Knife Radiosurgery for Pituitary Tumors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13194998. [PMID: 34638482 PMCID: PMC8508565 DOI: 10.3390/cancers13194998] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Pituitary tumors represent approximately 10–15% of all brain neoplasms. Gamma Knife, the most commonly used stereotactic radiosurgery technique worldwide, plays an important role in the treatment of several pituitary neoplasm. It is currently used in cases of residual or recurrent tumors after surgery or as primary treatment when surgery is contraindicated. Its goals are long-term tumor control, preservation of visual function, and, for secreting pituitary adenomas, endocrine remission. Several retrospective case-series (level of evidence IV) on Gamma Knife for pituitary tumors have been published describing encouraging outcomes; only one systematic review and meta-analysis on non-functioning pituitary adenoma has been recently reported. We provide a systematic review of the literature and meta-analysis from the last two decades on Gamma Knife radiosurgery for several pituitary tumors with the aim of describing and confirming safety and effectiveness of this technique. Abstract To describe and evaluate outcomes of Gamma Knife radiosurgery (GK) for the treatment of pituitary tumors over the past twenty years, a systematic review and meta-analysis according to PRISMA statement was performed. Articles counting more than 30 patients were included. A weighted random effects models was used to calculate pooled outcome estimates. From 459 abstract reviews, 52 retrospective studies were included. Among them, 18 reported on non-functioning pituitary adenomas (NFPA), 13 on growth hormone (GH)-secreting adenomas, six on adrenocorticotropic hormone (ACTH)-secreting adenomas, four on prolactin hormone (PRL)-secreting adenomas, and 11 on craniopharyngiomas. Overall tumor control and five-year progression free survival (PFS) estimate after one GK procedure for NFPA was 93% (95% CI 89–97%) and 95% (95% CI 91–99%), respectively. In case of secreting pituitary adenomas, overall remission (cure without need for medication) estimates were 45% (95% CI 35–54%) for GH-secreting adenomas, 64% (95% CI 0.52–0.75%) for ACTH-secreting adenomas and 34% (95% CI: 19–48%) for PRL-secreting adenomas. The pooled analysis for overall tumor control and five-year PFS estimate after GK for craniopharyngioma was 74% (95% CI 67–81%) and 70% (95% CI: 64–76%), respectively. This meta-analysis confirms and quantifies safety and effectiveness of GK for pituitary tumors.
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Affiliation(s)
- Luigi Albano
- Departments of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.R.B.); (P.M.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy
- Correspondence: (L.A.); (M.L.); Tel.: +390226432396 (L.A. & M.L.)
| | - Marco Losa
- Departments of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.R.B.); (P.M.)
- Correspondence: (L.A.); (M.L.); Tel.: +390226432396 (L.A. & M.L.)
| | - Lina Raffaella Barzaghi
- Departments of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.R.B.); (P.M.)
| | - Ajay Niranjan
- Departments of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (A.N.); (L.D.L.)
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (Z.S.); (J.C.F.)
| | - Zaid Siddiqui
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (Z.S.); (J.C.F.)
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - John C. Flickinger
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (Z.S.); (J.C.F.)
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Lawrence Dade Lunsford
- Departments of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (A.N.); (L.D.L.)
- Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; (Z.S.); (J.C.F.)
| | - Pietro Mortini
- Departments of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (L.R.B.); (P.M.)
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Uygur MM, Yazıcı DD, Buğdaycı O, Yavuz DG. Prevalence of vertebral fractures and serum sclerostin levels in acromegaly. Endocrine 2021; 73:667-673. [PMID: 34019235 DOI: 10.1007/s12020-021-02751-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE An increased prevalence of vertebral fractures (VFs) has been reported in previous studies. The aim of this study was to evaluate the association between bone mineral density (BMD), bone turnover markers, serum sclerostin levels, and vertebral fractures (VFs) in acromegaly patients. We also evaluated the effects of gonadal status, disease activity, treatment modality, age, sex, and body mass index (BMI) on skeletal endpoints. DESIGN Case-control study. PATIENTS AND MEASUREMENTS Seventy acromegaly patients (M/F:36/34, mean age 45.5 ± 11.9 years) and 70 controls (M/F:31/39; mean age 45.66 ± 11.9 years) were included. VFs, BMD, calcium metabolism, markers of bone turnover, and sclerostin levels were evaluated. BMD was measured by dual-energy X-ray absorptiometry (Hologic QDR 4500). Conventional lateral radiography of the spine was performed and the Genant method was used for the assessment of fractures of T4-L5 vertebrae. RESULTS The prevalence of vertebral fractures was higher in acromegalic patients as compared with the control group (72.9 vs. 20%; p < 0.001). Serum phosphate (P) levels (3.46 ± 0.59 mg/dl vs. 3.11 ± 0.44 mg/dl; p < 0.001) and b-cross laps (CTx) levels (0.47 µg/l, range 0.04-2.38 vs. 0.28 µg/l, range 0.11-0.80; p < 0.001) were significantly higher in acromegaly patients than control subjects. Serum sclerostin levels were similar between either acromegaly patients and control subjects or acromegaly patients with VF and without VF. In the means of treatment modality, VFs were more frequent in patients treated with adjuvant gamma knife radiosurgery (GKS) (p = 0.07). In the binary logistic regression analysis, the age of the acromegaly patients, the presence of hypogonadism, and GKS treatment were the factors significantly correlated with the occurrence of spinal fractures. CONCLUSIONS The prevalence of VFs in patients with acromegaly is higher than in control subjects. Since advanced age, the presence of hypogonadism and GKS treatment were the factors predicting VFs in acromegaly; radiological evaluations should be considered as an emerging tool especially in those patients. Although markers of bone turnover elevated in acromegaly, they were not useful for the prediction of fractures. Serum sclerostin levels showed no discrepancy between the two groups and further studies are required for assessment of sclerostin role in this form of secondary osteoporosis.
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Affiliation(s)
- Meliha Melin Uygur
- Division of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey.
| | - Dilek Dereli Yazıcı
- Division of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
| | - Onur Buğdaycı
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Division of Endocrinology and Metabolism, Marmara University School of Medicine, Istanbul, Turkey
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