{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T23:28:18Z","timestamp":1780788498770,"version":"3.54.1"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,10,5]],"date-time":"2015-10-05T00:00:00Z","timestamp":1444003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>For patient with a recurrent or residual acromegaly or Cushing's disease (<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>) after resection, gamma knife radiosurgery (<jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content>) is often used. Hypopituitarism is the most common adverse effect after <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> treatment. The paucity of studies with long\u2010term follow\u2010up has hampered understanding of the latent risks of hypopituitarism in patients with acromegaly or <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>. We report the long\u2010term risks of hypopituitarism for patients treated with <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> for acromegaly or <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From a prospectively created, <jats:styled-content style=\"fixed-case\">IRB<\/jats:styled-content>\u2010approved database, we identified all patients with acromegaly or <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> treated with <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> at the University of Virginia from 1989 to 2008. Only patients with a minimum endocrine follow\u2010up of 60 months were included. The median follow\u2010up is 159\u00b75 months (60\u00b71\u2013278). Thorough radiological and endocrine assessments were performed immediately before <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> and at regular follow\u2010up intervals. New onset of hypopituitarism was defined as pituitary hormone deficits after <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> requiring corresponding hormone replacement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients with either acromegaly or <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> were included. Median tumour volume at time of <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> was 1\u00b73 cm<jats:sup>3<\/jats:sup> (0\u00b73\u201313\u00b74), and median margin dose was 25 Gy (6\u201330). <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content>\u2010induced new pituitary deficiency occurred in 58\u00b73% (<jats:italic>n<\/jats:italic> = 35) of patients. Growth hormone deficiency was most common (28\u00b73%, <jats:italic>n<\/jats:italic> = 17). The actuarial overall rates of hypopituitarism at 3, 5 and 10 years were 10%, 21\u00b77% and 53\u00b73%, respectively. The median time to hypopituitarism was 61 months after <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> (range, 12\u2013160). Cavernous sinus invasion of the tumour was found to correlate with the occurrence of a new or progressive hypopituitarism after <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content> (<jats:italic>P<\/jats:italic> = 0\u00b7018).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Delayed hypopituitarism increases as a function of time after radiosurgery. Hormone axes appear to vary in terms of radiosensitivity. Patients with adenoma in the cavernous sinus are more prone to develop loss of pituitary function after <jats:styled-content style=\"fixed-case\">GKRS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.12938","type":"journal-article","created":{"date-parts":[[2015,10,5]],"date-time":"2015-10-05T15:35:15Z","timestamp":1444059315000},"page":"524-531","source":"Crossref","is-referenced-by-count":47,"title":["Gamma knife radiosurgery in patients with persistent acromegaly or Cushing's disease: long\u2010term risk of hypopituitarism"],"prefix":"10.1111","volume":"84","author":[{"given":"Or","family":"Cohen\u2010Inbar","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery University of Virginia Charlottesville VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Virginia Charlottesville VA 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