Zibar Tomšić Karin, Dušek Tina, Kraljević Ivana, Heinrich Zdravko, Solak Mirsala, Vučinović Ana, Ozretić David, Mihailović Marasanov Sergej, Hršak Hrvoje, Kaštelan Darko
a Vuk Vrhovac University Clinic for Diabetes , Endocrinology and Metabolic Diseases, Merkur University Hospital , Dugi Dol 4a, Zagreb , Croatia.
b Department of Endocrinology , University Hospital Centre Zagreb , Zagreb , Croatia.
Endocr Res. 2017 Nov;42(4):318-324. doi: 10.1080/07435800.2017.1323913. Epub 2017 May 24.
The aim of the study was to investigate the incidence of and risk factors for hypopituitarism after gamma knife radiosurgery (GKRS) for pituitary adenoma.
We conducted a retrospective analysis of the pituitary function of 90 patients who underwent GKRS for pituitary adenoma at the University Hospital Centre Zagreb between 2003 and 2014. Twenty seven of them met the inclusion criteria and the others were excluded from the study due to pituitary insufficiency which was present before GKRS. Eighteen patients had non-functioning and 9 patients had secretory adenomas. Median patients' age was 56 years (24-82). GKRS was performed using the Leksell gamma knife Model C. The median prescription radiation dose was 20 Gy (15-25) and the median tumor volume size was 3.4 cm (0.06-16.81). New onset hypopituitarism was defined as a new deficit of one of the three hormonal axes (corticotroph, thyreotroph, or gonadotroph) ≥3 months following GKRS. SPSS was used for statistical analysis, with the significance level at P<0.05.
During the median follow-up period of 72 months (range 6-144), 30% of patients developed new hypopituitarism after GKRS. This corresponds to incidence of one new case of hypopituitarism per 15 patient-years. Age, gender, tumor function, tumor volume, suprasellar extension, prescription dose of radiation, as well as dose-volume to the pituitary gland, stalk and hypothalamus were not predictive factors for the development of hypopituitarism.
In our cohort of patients with pituitary tumors who underwent GKRS, 30% developed new hypopituitarism during the follow-up period.
本研究旨在调查垂体腺瘤伽玛刀放射外科治疗（GKRS）后垂体功能减退的发生率及危险因素。
我们对2003年至2014年间在萨格勒布大学医院中心接受垂体腺瘤GKRS治疗的90例患者的垂体功能进行了回顾性分析。其中27例符合纳入标准，其余患者因GKRS前存在垂体功能不全而被排除在研究之外。18例患者为无功能腺瘤，9例患者为分泌性腺瘤。患者的中位年龄为56岁（24 - 82岁）。使用Leksell伽玛刀C型进行GKRS治疗。中位处方放射剂量为20 Gy（15 - 25），中位肿瘤体积大小为3.4 cm（0.06 - 16.81）。新发垂体功能减退定义为GKRS后≥3个月出现三个激素轴（促肾上腺皮质激素、促甲状腺激素或促性腺激素）之一的新缺陷。使用SPSS进行统计分析，显著性水平为P<0.05。
在中位随访期72个月（范围6 - 144个月）内，30%的患者在GKRS后出现新发垂体功能减退。这相当于每15患者年有1例新发垂体功能减退病例。年龄、性别、肿瘤功能、肿瘤体积、鞍上扩展、放射处方剂量以及垂体、垂体柄和下丘脑的剂量体积均不是垂体功能减退发生的预测因素。
在我们接受GKRS治疗的垂体肿瘤患者队列中，30%的患者在随访期间出现新发垂体功能减退。
