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Exp Clin Endocrinol Diabetes 2005; 113(4): 219-224
DOI: 10.1055/s-2005-837552
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Gamma-Knife Surgery is Effective in Normalising Plasma Insulin-Like Growth Factor I in Patients with Acromegaly

B. Gutt1 , B. Wowra2 , R. Alexandrov3 , E. Uhl4 , L. Schaaf3 , G. K. Stalla3 , J. Schopohl1
  • 1Department of Internal Medicine Innenstadt, University of Munich, Munich, Germany
  • 2Gamma-Knife-Zentrum, Munich, Germany
  • 3Max-Planck-Institute of Psychiatry, Dept. of Endocrinology, Munich, Germany
  • 4Department of Neurosurgery, University of Munich, Munich, Germany
Further Information

Publication History

Received: January 21, 2004 First decision: May 6, 2004

Accepted: September 16, 2004

Publication Date:
13 May 2005 (online)

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Abstract

Objective: For patients in whom acromegaly persists despite pituitary surgery or drug treatment, gamma-knife surgery represents an additional treatment option. Considering carefully the different reported biochemical outcomes, the central point is whether gamma-knife radiosurgery has advantages compared to conventional radiotherapy or, furthermore, to newer medical therapies, such as long-acting somatostatin analogues or growth hormone receptor antagonists. Design and Methods: We report the outcome of 44 patients with acromegaly, who received gamma-knife surgery with the Leksell gamma knife. The median follow-up time was 1.9 years (0.5 - 4.3 years) post-radiosurgery. 43 of 44 patients had previously undergone pituitary surgery. Results: Immediately prior to gamma-knife surgery, median xULN of patients' serum IGF-I was 1.9 times above upper limit of normal (range: 0.5 - 8.9 xULN [multiple of upper limit of normal range]). There was a significant decline of serum IGF-I at patients' final follow-up. We found a normal age-adjusted IGF‐I in 21/44 patients (xULN of IGF-I < 1). Furthermore, as the number of treated patients increased, we found an improvement in remission rate, which let us assume that there was a learning effect for the gamma-knife performing team over time. In addition, the median adenoma size decreased from 1.5 ml (0.1 - 6.9 ml) prior to gamma-knife therapy to 0.3 ml (no rest vol. detectable - 2.4 ml) at patients' last visit. Conclusion: We have shown that pituitary gamma-knife surgery is effective in lowering serum IGF-I levels. At the end of the follow-up period, 48 % of our cohort had normal age-adjusted IGF‐I levels.

Key words

Acromegaly - gamma-knife surgery - irradiation

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Dr. Bodo Gutt

Medizinische Klinik Innenstadt, Klinikum der LMU

Ziemssenstraße 1

80336 Munich

Germany

Phone: + 49(0)8951602111

Fax: + 49 (0) 89 51 60 45 66

Email: Bodo.Gutt@med.uni-muenchen.de

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