Ankara Üniversitesi Tıp Fakültesi Mecmuası 0365-8104 1307-5608 Ankara University Endocrinology Endokrinoloji Hipersomatotropinizmin Tedavisinde Hipofiz Işınlamasının Değeri, Tedavi Sonuçlarının Takibinde Faydalı Olan Kriterler Ve Kobalto-Terapi İçin Hasta Seleksiyonu The Value of Pituitary Irradiation in the Treatment of Hypersomatotropinism, Criteria Useful for Monitoring Treatment Outcomes, and Patient Selection for Cobalt Therapy Koloğlu Selahattin ANKARA ÜNİVERSİTESİ, ANKARA TIP FAKÜLTESİ 12 30 1974 27 3-4 757 784 09 01 1974 12 30 1974 Copyright © 1947, Ankara Üniversitesi Tıp Fakültesi Mecmuası 1947 Ankara Üniversitesi Tıp Fakültesi Mecmuası

Hipofizer gamma teleradyoterapiye tabi tutulmuş 40 akromegali ve jigantizm vakasında somatotropin (STR) salgısının statik ve dinamik incelemeler ile tedavi sonuçları değerlendirilmiştir. Hipofizer kobalto - terapi şeklinde gerçekleştirilen tedavi ile vakaların 6 57,5 - 65,0'inde münasip sonuçlar elde edilmiştir. Bazal STH seviyelerinin normale avdeti ve otonominin kaybolarak, yerini normal dinamik cevaplara bırakması tam muvaffakiyetin işaretleridir. Tedavinin etkisinin 6 ay sonra başladığı, fakat STH sekresyonunun 2 yıl sonra normalleştiği tespit edilmiştir. Bu tedaviye bağlı hiç bir önemli komplikasyon husule gelmemiştir. Hipersomatotropinizm tedavisinde faydalanılan diğer yöntemlerle elde edilen sonuçlar biraz daha iyi olmakla beraber, bu tedavi yolları ile husule gelen yan etkilerin, fotonterapide müşahede edilmemesi, bu farkı kapamaya yeterli sayılmalıdır. Fotonterapiden, kompresyonsuz ve sella dışı inkişaf göstermiyen hipofizer lezyonların ilk tedavisi olarak taydalanılmaya devam edilmelidir. Kobalto - terapinin etkisi yavaştır; etiolojik lezyonun biyolojik veya anatomik evolusyona devam ettiği vakalar hariç, tedaviyi takiben 2 yıl geçmeden yeni bir tedavi yöntemi tatbikine geçmemeli, hastanın müşahede altında tutulmas ile iktifa edilmelidir.

The results of treatment were evaluated using static and dynamic studies of somatotropin (STR) secretion in 40 cases of acromegaly and gigantism treated with pituitary gamma teleradiotherapy. Treatment with pituitary cobalt therapy yielded favorable results in 6.57 to 65.0% of cases. Complete success was demonstrated by the return to normal baseline STH levels and the disappearance of autonomy, replaced by normal dynamic responses. The effects of the treatment began after 6 months, but STH secretion normalized after 2 years. No significant complications were observed with this treatment. While the results obtained with other methods used in the treatment of hypersomatotropinism are somewhat better, the fact that the side effects observed with these methods are not observed with photontherapy should be considered sufficient to compensate for this difference. Phototherapy should continue to be used as the initial treatment for pituitary lesions that do not exhibit compression or extrasellar development. Cobalt therapy has a slow onset of action; except in cases where the etiological lesion continues to undergo biological or anatomical evolution, a new treatment modality should not be implemented within two years of treatment, and the patient should be kept under observation.

 acromegaly pituitary irradiation somatotropin hipofiz ışınlaması Akromegali somatotropin Ankara University Faculty of Medicine, Department of Endocrinology and Metabolic Diseases 1 - Adams, J. et al.: Transphenoidal cryohypophysectomy in acromegaly. Clinical and Endocrinological evaluation. J. of Neurosurgery, 28/1:100, 1968. 2 - Aurugkin, T. W., Sau, K.: Childhood acromegaly; successful therapy with conventional radiation and effects of chlorpromazine on growth hormone and prolactin secretion. J. Clin. Endocr. and Meta., 37/3:380, 1973. 3 - Beck, P. et al.: Correlation studies of growth hormone and insulin plasma concentration with metabolic abnormalities in acromegaly. J. Lab. Clin. Med., 66:366, 1965. 4 - Bronson, A. B.: Surgical hypophysectomy as a treatment for acromegaly. Clin. Endocr., 11:93, 1968. 5 - Christy, N. P.: Pituitary radiation treatment. Hosp. Proc., 4:54, 1969. 6 - Collins, W. F.: Hypophysectomy: Historical and personal perspective. Clinical Neurosurgery, 21:68, 1974. 7 - Conway, L. W., Collins, W. F.: Results of trans-sphenoidal cryohypophysectomy for carcinoma of the breast. New Eng. J. of Med., 281:1, 1969. 8 - Correa, J. N., Lampe, I.: Radiation treatment of pituitary adenomas. J. Neurosurgery, 19:626, 1962. 9 - Cross, N. N. et al.: Treatment of acromegaly by cryosurgery. Lancet, 1:215, 1972. 10 - Cryer, P. E., Daughaday, W. H.: Studies on etiology of Acromegaly. J. Clin. Endocr., 29:386, 1969. 11- Dashe, A. M. et al.: Steretaxic hypophyseal cryosurgery in acromegaly and other disorders. J. of Amer. Med. Ass., 198:591, 1966. 12 - Dillon, R. S.: Endocrinology. Lea and Febiger, 1973. 13 - Edelstyn, G. A., Gleadmill, C. A.: Hypophysectomy combined with intracellular irradiation with Ittrium-90. Lancet, 7018:462, 1958. 14 - Fager, C. A.: Surgery of sellar and parasellar tumors. Clin. Neurosurgery, 17:209, 1970. 15 - Forrest, A. P. M., Blair, D. W.: Screw-implantation of the pituitary with Ittrium-90. Lancet, 7039:192, 1958. 16 - Frantz, A. G.: Effects of estrogen and sex difference on studies of human growth hormone. J. Clin. Endocr. and Meta., 25:1470, 1965. 17 - Fraser, R., Joplin, G. F.: Needle implantation of Ittrium seeds for pituitary ablation. Lancet, 7069:382, 1959. 18 - Fraser, T. R., Wrigt, A. D.: Treatment of acromegaly and Cushing's disease by Y-90 implant for partial ablation of the pituitary. Clin. Endocr., 11:78, 1968. 19 - Gershberg, H. et al.: Effect of medroxy-progesteron on STH secretion. Obstet. and Gynec., 33:383, 1969. 20 - Glick, S. M. et al.: The regulation of growth hormone secretion. Rec. Prog. in Hor. Res., 21:241, 1965. 21 - Goldberg, M. B. et al.: Malignant intracranial neoplasms following radiation therapy for acromegaly. Radiology, 80:465, 1963. 22 - Gordon, P., Roth, J.: Conventional radiotherapy in acromegaly. Third International Congress of Endocrinology, p.45, 1968. 23 - Greenblatt, R. B.: Estrogen therapy in inhibition of growth. J. of Clin. Endocr. and Meta., 26/11:1185, 1966. 24 - Greenhouse, A. H.: Pituitary sarcoma a possible consequence of radiation. J. A. M. A., 190:269, 1964. 25 - Greenwood, F. C. et al.: Ittrium implantation in the treatment of acromegaly. Lancet, 2:555, 1965. 26 - Ramwi, G. J. et al.: Pituitary radioresistence. Amer. J. of Med., 29:690, 1960. 27 - Hardy, J.: Transphenoidal microsurgery of the normal and pathological pituitary. Clin. Neurosurgery, 16:185, 1969. 28 - Hartog, M. et al.: Partial pituitary ablation with implants of gold-198 and Ittrium-90 for acromegaly. Brit. Med. J., 2:396, 1965. 29 - Jadresic, A. et al.: Stereotaxic pituitary implantation of Ittrium-90 and Iridium-192 for acromegaly. J. of Clin. Endocr. and Meta., 27/10:1503, 1967. 30 - Joplin, G. F. et al.: Partial pituitary ablation by needle implantation of Gold-198 seeds for acromegaly and Cushing's disease. Lancet, 2:1277, 1961. 31 - Josimovich et al.: Effect of estrogenic agents on STH secretion. Endocrinology, 81:1428, 1967. 32 - Kaufman, B., Pearson, O. H. Shealy, C. N.: Transasal-transsphenoidal Ittrium-90 pituitary implantation in the therapy of acromegaly. Radiology, 86:915,1966. 33 - Kjellberg, R. N., Shintani, A. et al.: Proton beam therapy in acromegaly. New Eng. J. Med., 278:689,1968. 34 - Kjellberg, R. N.: Proton beam irradiation of the pituitary. Clinical Endocrinology, 11:103,1968. Grune and Stratton. 35 - Kolodny, H. D., et al.: Acromegaly treated with chlorpromazine. A case study. New Eng. J. Med., 284:819,1971. 36 - Lawrence, J. H.: Alpha particuls and proton beams in therapy. J. A. M. A., 186:236,1963. 37 - Lawrence, A. M. et al.: Etiology of acromegaly. J. of Lab. Clin. Med., 74:876,1969. 38 - Lawrence, A. M., Kirsteins, L.: Progestins in medical management of acromegaly. J. Clin. Endocr., 30/5:646,1970. 39 - Lawrence, J. H. et al.: Successful treatment of acromegaly: Metabolic and clinical studies in 145 patients. J. of Clin. Endocr., 31:180,1970. 40 - Lawrence, A. M., Pinsky, S. M.: Conventional radiation therapy in acromegaly. Arch. Intern. Med., 128:369,1971. 41 - Levene, M. B.: Pituitary radiotherapy. Radiol. Clin. North. Amer., 5:333,1967. 42 - Linfoot, J. A., Greenwood, F. C.: Growth hormone in acromegaly. Effect of heavy particles pituitary irradiation. J. of Clin. Endocr., 25:1515,1965. 43 - Mautalen, C., Horwith, M.: Surgical hypophysectomy as a treatment for acromegaly. Clinical Endocrinology, 11:93,1968. Grune and Stratton. 44 - Mc Combs, A.: Proton irradiation of pituitary and its metabolic effects. Year Book of Endocrinology., pp. 24,157-1958. 45 - Mc Cullagh, P. et al.: Treatment of acromegaly with estrogenic agents. Diabetes, 4:13,1955. 46 - Mintz, D. H. et al.: Effect of estrogens in acromegaly. J. of Clin. Endocr., 27:1321,1967. 47 - Molinatti, G. M. et al.: Implantation of ittrium in the sella turcica in sixteen cases of acromegaly. J. of Clin. Endocr. and Meta., 22:599,1962. 48 - Molinatti, G. M.: Implantation of the sella turcica with Ittrium-90 in the treatment of Cushing's syndrome of pituitary origin. J. of Clin. End. and Meta., 27/6:861,1967. 49 - Peck, F. C. et al.: Radiation necrosis of the brain in acromegaly. J. Neurosurgery, 25:536,1966. 50 - Poppen, J. L.: High voltage radiation in the treatment of acromegaly. Bull. N. Y. Acad. Med., 39:21,1963. 51 - Rand, R. W.: Stereotaxic cryohypophysectomy. J. A. M. A., 189:255, 1964. 52 - Rand, R. W.: Cryosurgery of the pituitary in acromegaly reduced growth hormone levels following hypophysectomy in 13 cases. Ann. Surg., 164:587, 1966. 53 - Rand, R. W. et al.: Cryosurgery in the treatment of acromegaly. Trans Amer. Neurol. Ass., 91:324, 1966. 54 - Rand, R. W.: Hypophysectomy in endocrine disorders. Clin. Neurosurgery, 17:226, 1970. 55 - Ray, B. S. et al.: Surgical hypophysectomy as a treatment for acromegaly. Clinical Endocrinology, 11:93, 1968. (Editor: Astwood). 56 - Ray, B. S.: Intracranial hypophysectomy J. of Neurosurgery, 28:180, 1968. 57- Roth, S. et al.: Acromegaly and other disorders of growth hormone secretion. Ann. Intern. Med., 66:760, 1967. 58 - Roth, J., Gordon, P., Brace, K.: Efficiency of conventional pituitary irradiation in acromegaly. New Eng. J. Med., 282:1385, 1970. 59 - Sahnd, G. R., Nadau, A.: Late effects of cobalt therapy on growth hormone secretion. Third International Congress of Endocrinology. Excerpta Medica, 157:46, 1968. 60 - Schwartz, E. E. et al.: Effect of estrogens on STH secretion. J. Clin. Invest., 46:1115, 1967. 61 - Schwartz, E. E. et al.: Treatment of acromegaly with estrogens. J. Clin. Invest., 48:260, 1969. 62 - Shellne, G. E.: Pituitary irradiation for acromegaly. Radiology, 76:70, 1961. 63 - Sherman, L., Kolodny, H. D.: Brain-catercholamine, and drug therapy for gigantism and acromegaly. Lancet, 1/7701:682, 1971. 64 - Silver, S.: Hypophysectomy with radioactive isotopes (Y-90). Radioactive isotopes in Med. and Biology., Vol: II, pp. 272, 1962 (Lea and Febiger). 65 - Simon, S. M. et al.: Effect of medroxyprogesteron on the STH secretion. J. Clin. Endocr., 27:1633, 1967. 66 - Stern, W. E., Batzdorf, U.: Intracranial removal of pituitary adenomas. An evaluation of varying degrees of excision from partial to total. J. of Neurosurg., 33:564, 1970. 67 - Thomas, K. E.: Trans-septal extranasal approch to the pituitary. Lancet, 7362:735, 1964. 68 - Williams, R. H.: Textbook of endocrinology. Saunders Company, 1974. 69 - Wirth, F. et al.: Pituitary adenomas: Factors in treatment. Clinical Neurosurgery, 21:8, 1974. 70 - Wright, A. D. et al.: Ittrium-90 and Gold-198 implantation in the treatment of pituitary adenomas. Quart. J. of Med., 39:1, 1970. 71 - Zervas, N. T.: Stereotaxic radiofrequency surgery of the normal and the abnormal pituitary gland. New Eng. J. Med., 280:429, 1969.