Inefficiency of the anticoagulant therapy in the regression of the radiation-induced optic neuropathy in Cushing's disease

Radiation-induced optic neuropathy is a rare complication (prevalence less than 1%) following radiotherapy of the sellar region. However, the vasculop athy in Gushing's disease predisposes to radiation-induced injury. We repor t the case of a 24-year-old man with Gushing's disease since he was 16. The hormonal study including bilateral inferior petrosal sinus catheterization diagnosed a pituitary right lesion, but imagiology was always negative. He underwent a transsphenoidal microadenomectomy and the pathological study s howed the presence of corticotrophic hyperplasia but no adenoma. Secondary hypothyroidism and hypogonadism as well as permanent diabetes insipidus wer e diagnosed and because the patient was not cured he underwent a second tra nssphenoidal total hypophysectomy. After that and because he was still hype rcortisolemic, pituitary external irradiation was given in a total dose of 6000 rad. Six months later he developed progressive bilateral visual loss. Cerebral MR revealed focal enhancement of the enlarged optic nerves and chi asm, associated with demyelination areas of the posterior visual pathways. Treatment was tried first with high doses of corticosteroids and later with anticoagulants-heparin EV. 1000 U/h during 7 days followed by warfarin, bu t unsuccessfully, probably because the patient was already amaurotic at the beginning of the last treatment. (J. Endocrinol. Invest. 22: 301-305, 1999 ) (C)1999, Editrice Kurtis.