Persistent or recurrent acromegaly: long-term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy

Article Abstract:

Acromegaly is a metabolic disturbance which results in the increased growth of the bones in the arms and legs, as well as some bones of the head, including the jaw. The disorder, which generally affects middle-aged people, is the result of abnormally increased synthesis of growth hormone by the pituitary gland. In many cases, this increase in growth hormone production is a consequence of the development of a pituitary tumor. Surgical removal of the pituitary tumor is a rapid and generally safe treatment, but the effectiveness is less than optimal. More than 40 percent of patients will require additional treatment after surgery. One of the treatments available for patients whose disease has not been cured by surgery is the application of radiation to the pituitary and parasellar structures. (The pituitary is located within a bony cavity called the sella turcica.) The authors report their experience with the use of megavoltage radiation therapy in the treatment of 24 patients with acromegaly. The patients had levels of growth hormone in their blood exceeding 5 nanograms per milliliter (ng/ml), indicating that surgical treatment had failed to control the pituitary tumor. Of the 22 patients available for follow-up, 12 had growth hormone levels which had been brought under the 5 ng/ml level. However, the growth hormone levels for all patients were dropping in the years following radiation treatment, and it is possible that the remaining 10 patients will achieve levels of growth hormone under 5 ng/ml with the passage of time. No major side effects resulting from the radiation therapy were observed, but pituitary function itself was reduced, as would be expected. The reduction in pituitary functions other than growth hormone production required the administration of glucocorticoid hormones in seven patients, sex hormones in five, and thyroid hormones in five. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Acromegaly, Pituitary gland tumors, Pituitary tumors

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Survival rates in patients with differentiated thyroid carcinoma

Article Abstract:

Differentiated thyroid cancers, in which the cancer cells continue to behave like thyroid cells and secrete thyroid hormones, are generally treated with both surgery and radioactive iodine. Conveniently, the thyroid sequesters the radioactive iodine and irradiates itself while sparing the rest of the body exposure to the radiation. The course of thyroid cancer is often benign, and long-term survival is commonplace. Consequently, there have been few studies conclusively demonstrating the effectiveness of post-surgical radiation in the treatment of this cancer. To learn more about the role of post-operative radiation in the treatment of thyroid cancer, the records of 932 patients were examined, of whom 346 received external irradiation in addition to the standard treatment. A review showed that there was no statistically significant difference between the survival of those receiving post-operative radiation and those who did not. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Cancer, Thyroid cancer

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