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Long Term Follow-Up of Patients with Cushing's Disease Treated by Interstitial Irradiation

Departments of Medicine and Radiology (D.H.C.), Royal Postgraduate Medical School, Hammersmith Hospital London, W12 OHS United Kingdom

Address requests for reprints to: Dr. Laurence M. Sandier, Endocrinology, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London, W12 OHS United Kingdom.

The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3–26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred.

Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T₄ replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years.

Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectbmy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.

^* Present address: Clinical Reagents Research and Development Department, Amersham International pic, Amersham, Bucks, HP7 9LL United Kingdom.

Received December 10, 1986.

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