| Abstract
Introduction: Pituitary adenomas are categorized into two groups: the secretory and non-secretory adenomas. The first group
overproduce normal pituitary hormones, which cause Cushing’s disease (high ACTH- adernocorotitrophic hormone), Acromegaly
and prolactinomas. They may diffuse into the sphenoid sinus, cavernous sinus and diaphragma sellae. Tumor invasion into the adjacent
structures and incomplete tumor resection are the mostcommoncauses of hypercortisolemia after the first surgery. The first
explored radiation modality for persistent Cushing’s disease was fractionated radiation, with increased rates of hypopituitarism.
Over time, several studies demonstrating the power of the GKS (gamma knife surgery) for persistent Cushing’s disease.
Case Presentation: A 32-year-old female who was diagnosed with Cushing’s disease secondary to an ACTH secreting pituitary adenoma,
underwent trans-sphenoidal resection of the adenoma. Surprisingly, no postoperative hormonal and clinical improvements
were observed. The patient was treated with oral ketoconazole. Twenty months after surgery, she had complaints of sudden onset
of headache with diplopia, ptosis and paralysis of extraocular muscles of the left eye. A repeat MRI revealed residual tumor with
local invasion to the left cavernous sinus. Following the consultation with a neurosurgeon, the patient underwent GKS. Within two
months, there was a significant improvement in peribulbar muscle paresis and laboratory results were satisfying.
Conclusions: The case presented here indicates that the most common indicators for radiosurgery are residual tumors, especially
in the cavernous sinus, which are recurrent and/or resistant to medical treatment. The purpose is to call attention to the GKS as a
successful adjunctive therapy in Cushing’s disease. |