TREATMENT OF CUSHINGS-DISEASE BY INTERSTITIAL PITUITARY IRRADIATION -SHORT-TERM AND LONG-TERM FOLLOW-UP

Trans-sphenoidal intrasellar implantation of radioactive rods was empl oyed to treat Gushing's disease in our Institution between 1958 and 19 81, The patients were followed at regular intervals after the procedur e, The aim of this work is to assess retrospectively the results, comp aring the short- (1 year) and long-term (average 21.8 years) effects o f this treatment, Seventy-six patients received pituitary implantation of Y-90- and one of Au-198-labelled rods, delivering a dose of 100-15 0,000 rad. Complete remission was obtained in a few weeks to months in 57/76 patients (5 of whom required a second implantation); 2 patients died of meningoencephalitis and 3 of cardiovascular complications ass ociated with hypercortisolism 1 to 2 months after surgery, In 12 patie nts bilateral adrenalectomy or external pituitary irradiation were req uired to achieve remission; one of them developed Nelson's syndrome 15 years after implantation, Two were lost at follow-up, Long-term follo w-up was possible in 41 patients of the initial series, Of these, 40 w ere cured of the disease, with hypoadrenalism developing in 25, while recurrence was observed only in the patient treated with Au-198, The i ncidence of hypothyroidism was 50%, and that of hypogonadism 54%, Perm anent diabetes insipidus developed in 1 subject, GH deficiency resulti ng in retarded growth was found in the youngest patient, who had been operated at the age of 14, In conclusion, interstitial irradiation of pituitary adenomas was a safe and effective procedure for the treatmen t of Gushing's disease.