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Email Dr. Jeffery Williams (jw@jhu.edu). For pituitary gland tumors including Cushings disease, the decisions related to treatment for the pituitary gland tumors depend upon the complete understanding of the competing risks vs. benefits for the different treatments. Options for Cushing's disease treatments may include surgery or radiosurgery. The FSR (fractionated stereotactic radiosurgery) for pituitary tumors is an important option for treatment for Cushing's disease. The important considerations include the size and rate of growth of the pituitary tumor causing Cushing's disease as well as the progression of any symptoms caused by the ACTH production in Cushing's disease.

Click Here for Dr. Williams C.V. Curriculum Vitae: Dr. Jeffery Williams
Director, Brain Tumor Radiosurgery
The Johns Hopkins Hospital
Board Certified: Neurological Surgery
Board Certified: Radiation Oncology
Email Dr. Jeffery Williams.

Email Address: jw@jhu.edu
Phone: 410-614-2886
Fax: 410-614-2982


Cushings Disease On-Line Consultation

  • Pituitary tumors can be treated with surgery, radiotherapy, radiosurgery and/or medications.

  • For On-Line Consultation please complete and send the Patient and Tumor Info and email Dr. Williams jw@jhu.edu.

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Cushings Disease Topics


Cushing's Disease

Pituitary adenomas cause specific clinical syndromes.



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Cushing's disease has specific signs and symptoms that are primarily related to the endocrinopathies produced by hypersecretion.

  • Cushing's syndrome results from hypercortisolism and is characterized by distinctive clinical features. Patients may develop obesity, hirsutism (abnormal hair distribution), purple striae (stripes) on the skin, mental problems, poor wound healing and muscle wasting.
  • Cushing's syndrome is a result of increased production of ACTH (adrenocorticotrophic hormone). This hormone stimulates the adrenal gland to synthesize and produce cortisol. The cortisol is a hormone that can result in increased production of glucose, raise blood pressure and result in redistribution of body tissues.
Microsurgical resection of pituitary tumors in Cushings disease can be done via two approaches.

Microsurgical resection of pituitary adenomas can be done via two approaches.

  • The transphenoidal approach allows resection of small to medium-sized tumors. The risks of surgery include CSF (spinal fluid leak) and meningitis. The rates of these complications are low, however.

  • Patients with Cushing's disease often have associated medical problems such as obesity, hypertension, and diabetes that increase the risk associated with surgery. However, because most of these patients are relatively young and their pituitary tumors are usually small, it is somewhat less likely that they will suffer from complications of the surgery itself.

  • In one surgical series (Laws et. al. J. Neurosurgery August 1999 Volume 91 Number 2) seven patients had complications specifically related to the surgical procedure. In one patient, permanent unilateral ocular neuropathy with no subsequent visual improvement occurred as a result of a misdirected approach. The postoperative CT scan did not reveal a fracture of the optic canal, and the injury was presumed to be related to direct contusion of the optic nerve or vasospasm. In another patient, early reoperation and packing of the sphenoid sinus with fat was used to control postoperative CSF rhinorrhea. One patient with a macroadenoma developed a transient third cranial nerve palsy, presumably related to removal of tumor from the cavernous sinus. A CT scan demonstrated no intracranial disease, and the third cranial nerve function returned to normal during the following 3 days. Epistaxis (nose bleed) occurred 3 weeks after surgery in a single patient, requiring cauterization of the sphenopalatine artery. There were two patients with nasal septal perforations seen on postoperative follow-up images, but both were asymptomatic. These patients had mucosal tears noted at the time of surgery, and an attempt was made to repair these tears during closure; neither of these patients had overt diabetes mellitus. Finally, dehiscence of the abdominal fat graft site developed in one patient.

Stereotactic Radiosurgery offers non-invasive control of newly diagnosed or recurrent pituitary tumors.

Stereotactic Radiosurgery allows specific irradiation of only the pituitary tumor. Narrow beams of radiation specifically target only the pituitary tumor. The normal brain is spared and does not receive significant exposure. The treatment results in control of the majority of tumors and their endocrinological sequelae. Stereotactic radiosurgery may be particularly suitable for functional pituitary adenomas (Cushing's disease, Acromegaly) to reduce the level of hormonal secretion. For recurrent pituitary adenomas after conventional surgery and radiation, stereotactic radiosurgery is particularly appropriate, allowing sparing of the optic nerves with delivery of high radiation dose to the recurrent pituitary adenoma.

The patient information may be submitted.

Stereotactic Radiosurgery offers specific, local treatment to the pituitary adenoma with sparing of surrounding normal tissues.




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Pituitary Adenoma Patient and Tumor Information



The form below is of interest to patients who have Cushings disease. It outlines many of the important questions related to pituitary adenoma and its treatment. The treatment options for pituitary adenomas are multi-factorial and depend upon many different characteristics of the patient and the tumor. The form can be sent to Dr. Williams using the "Send Form" button at the end of the page. Dr. Williams can subsequently correspond regarding the issues related to the treatment options for Cushings disease. This information helps determine which of the different therapies may be helpful for treatment. Even though all of the information below may not be available, please submit all that is known.

There are two ways to relay the information:

  • Email Dr. Williams regarding Cushings Disease treatment options: Dr. Jeffery Williams

  • Send the form and include your email address in the box at right (if response is desired):

Please enter the responses and click on the "Submit Form" button at the end of this form.

Date of Diagnosis

What is the DATE of the diagnosis of the Cushings disease?





  • Method of Diagnosis

    How was the first pituitary adenoma diagnosed?

    Craniotomy

    Endocrine studies (blood tests)

    Only radiographically





  • Location

    What was the location of the pituitary adenoma?

    Sella Turcica (Normal Location)

    Extension beyond sella (suprasellar or into cavernous sinus(es))




  • Size: What is the size of the pituitary adenoma (largest dimension)?

    Less than one centimeter

    Greater than one, but less than two centimeters

    Greater than two, but less than three centimeters

    Greater than three centimeters





  • Endocrine Studies

    Does the patient have above-normal secretion of any hormone(s) (ACTH) by the pituitary pituitary adenoma as documented by laboratory studies?

    No

    Yes


    (Please list hormone(s):

    ACTH

    Other:





  • Syndromes

    Does the patient have either of the following symptoms?
    Hypertension

    Obesity

    Gastric Ulcer





  • First (Prior) Treatment (if applicable): How was the first pituitary adenoma of Cushings disease treated?

    Observation Only

    Medication

    Subtotal Resection

    Total Resection

    Surgery (subtotal or total) and radiation





  • Date First Treatment

    What was the DATE of the treatment for the FIRST pituitary adenoma associated with Cushings disease?







Current Cushings Disease
  • What is the DATE of the DIAGNOSIS of the CURRENT pituitary adenoma (if current is different from above)? This pituitary adenoma is for consideration for the CURRENT radiosurgery or surgical resection.





  • Growth of Tumor

    Has the pituitary adenoma GROWN in size since a prior treatment or initial diagnosis?

    No

    Yes





Surgical Management of Current Tumor
  • Prior to Radiosurgery, if given, how is the CURRENT pituitary adenoma (or group of pituitary adenomas) surgically treated?

    Subtotal Resection

    Total Resection

    No Surgery






Histology:
  • Please enter the histology:

    Benign

    Malignant

    Atypical

    Other (not listed above):




Thank you for completing the Johns Hopkins Pituitary Adenoma Questionnaire.


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