JOHNS HOPKINS Pituitary
Radiosurgery Appointment
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Johns Hopkins
Cushings Disease
Radiosurgery
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.
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.
The Pituitary Tumor Mailing List
Cushings Disease Topics
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Cushing's Disease
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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.
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Microsurgical resection of pituitary tumors in Cushings disease can be done
via two approaches.
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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.
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Stereotactic Radiosurgery offers non-invasive control of newly diagnosed or
recurrent pituitary tumors.
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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.
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The patient information may be submitted.
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Stereotactic
Radiosurgery offers specific, local treatment to the pituitary adenoma with
sparing of surrounding normal tissues.
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Pituitary
Tumor Appointment Newsletter
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Pituitary Tumor News Glossary Prolactinoma
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