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J Clin Endocrinol Metab. 2006 Apr;91(4):1239-45. Epub 2006 Jan 10.

Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly.

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  • 1Department of Endocrinology, St. Bartholomew's Hospital, London EC1A 7BE, United Kingdom. P.J.Jenkins@qmul.ac.uk

Abstract

BACKGROUND:

There has been recent controversy as to the effectiveness of conventional pituitary irradiation in reducing circulating GH levels to less than 2.5 ng/ml and/or normalization of serum IGF-I.

OBJECTIVES:

Our objectives were to determine the effects of conventional pituitary irradiation on 1) lowering of serum GH and IGF-I levels, 2) the proportion of patients who achieve a GH level less than 2.5 ng/ml and a normal age-corrected IGF-I and the time taken to achieve this, and 3) the incidence of hypopituitarism and other adverse effects.

DESIGN:

We conducted retrospective data collection from 14 centers throughout the United Kingdom.

PATIENTS:

We studied 1840 patients with acromegaly, of whom 884 had received conventional pituitary irradiation.

MEASUREMENTS:

We assessed circulating GH and IGF-I levels and pituitary function at intervals after irradiation.

RESULTS:

Mean GH levels declined from 13.5 to 5.3 ng/ml at 2 yr after irradiation, to 2.0 ng/ml by 10 yr, and to 1.1 ng/ml at 20 yr. Twenty-two percent of patients achieved a level less than 2.5 ng/ml by 2 yr, 60% by 10 yr, and 77% by 20 yr. The interval to achieve this depended on the preirradiation GH level. IGF-I levels fell in parallel to those of GH with 63% of patients having a normal level by 10 yr. The proportions of patients with new pituitary hormone deficiencies 10 yr after irradiation were 18% for LH/FSH, 15% for ACTH, and 27% for TSH. No other side effects were noted.

CONCLUSIONS:

In this, the largest series reported, conventional pituitary irradiation is shown to be an effective and safe means of reducing both serum GH and IGF-I concentrations in patients with acromegaly.

PMID:
16403824
DOI:
10.1210/jc.2005-1616
[PubMed - indexed for MEDLINE]
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