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Submitted on July 20, 2005
Accepted on January 4, 2006
Depts of Endocrinology, St Bartholomew's Hospital, London, Jersey Hospital, Royal Infirmary, Edinburgh, Queen Elizabeth Hospital, Birmingham, and Churchill Hospital, Oxford
* To whom correspondence should be addressed. E-mail: P.J.Jenkins{at}qmul.ac.uk.
Background: There has been recent controversy as to the effectiveness of conventional pituitary irradiation in reducing circulating growth hormone (GH) levels to < 2.5 ng/ml and/or normalization of serum IGF-I
Objectives: To determine the effects of conventional pituitary irradiation on: (i) lowering of serum GH and IGF-I levels; (ii) the proportion of patients who achieve a GH level < 2.5 ng/ml and a normal age-corrected IGF-I and the time taken to achieve this; and (iii) the incidence of hypopituitarism and other adverse effects.
Design: Retrospective data collection from 14 centers throughout the United Kingdom
Patients: 1840 patients with acromegaly of whom 884 had received conventional pituitary irradiation.
Measurements: Circulating GH and IGF-I levels and pituitary function at intervals after irradiation.
Results: Mean GH levels declined from 13.5 to 5.3 ng/ml at 2 yr post irradiation, to 2.0 ng/ml by 10 yr and to 1.1 ng/ml at 20 yr. 22% of patients achieved a level < 2.5 ng/ml by 2 yr, 60% by 10 yr and 77% by 20 yr. The interval to achieve this depended on the pre-irradiation GH level. IGF-I levels fell in parallel to those of GH with 63% of patients having a normal level by 10 yr. The proportions of patients with new pituitary hormone deficiencies 10 yr after irradiation were 18% for LH/FSH, 15% for ACTH and 27% for TSH. No other side effects were noted.
Conclusions: In this, the largest series reported, conventional pituitary irradiation is shown to be an effective and safe means of reducing both serum GH and IGF-I concentrations in patients with acromegaly.
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