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LAURENCE M. SANDLER, NICHOLAS T. RICHARDS, DENIS H. CARR, KEITH MASHITER, GRAHAM F. JOPLIN, Long Term Follow-Up of Patients with Cushing's Disease Treated by Interstitial Irradiation, The Journal of Clinical Endocrinology & Metabolism, Volume 65, Issue 3, 1 September 1987, Pages 441–447, https://doi.org/10.1210/jcem-65-3-441
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The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3–26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred.
Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T4 replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years.
Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectbmy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.
