LONG-TERM FOLLOW-UP OF CUSHINGS-DISEASE TREATED WITH RESERPINE AND PITUITARY IRRADIATION FOLLOWED BY SUBTOTAL ADRENALECTOMY

Subtotal adrenalectomy was given to 10 adult patients with Cushing's d isease, concurrently with or following therapeutic regimen by long ter m reserpine administration and pituitary irradiation. In the present s tudy, we describe long term follow-up results. Two patients died after the operation due to acute adrenal crisis and pneumonia, respectively . The other 8 patients achieved clinical and biochemical remissions an d were followed for long term. Three patients relapsed 9, 14 or 17 yea rs after achieving remission, two patients developed hypopituitarism 1 2 or 20 years after and one died of cerebral vascular accident at 64 y ears, 5 years after the remission. The remaining 2 patients maintained remission for 10 or 18 years, respectively. During the remission peri ods of 0.5 to 20 years with a mean of 10.1 +/- 6.7 years, 6 of 7 patie nts examined by 1 mg overnight dexamethasone test showed normal suppre ssibility of plasma cortisol. Provocative tests of plasma GH by l-argi nine infusion and/or insulin-induced hypoglycemia mere performed in 6 patients in the early remission period. All of 5 patients in the argin ine infusion test and 3 of 5 in the insulin-induced hypoglycemia test showed normal responses. Furthermore, to facilitate prediction of long term response or failure to our therapeutic regimen, long term reserp ine administration and pituitary irradiation, pretreatment clinical an d biochemical characteristics were analyzed retrospectively in 3 divid ed groups; the present 10 patients treated with reserpine and pituitar y irradiation followed by subtotal adrenalectomy, 11 patients achievin g long term remission treated by our regimen alone, and 7 patients fai led with our regimen alone. There mere no significant factors predicti ve of response to our regimen. These findings suggest that subtotal ad renalectomy does not lead favorable outcome, however, reserpine admini stration shows usefulness to improve pituitary functions in treating C ushing's disease.