{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:36:01Z","timestamp":1791387361972,"version":"4.3.3"},"reference-count":176,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>Treatment of Cushing\u2019s disease (CD) is one of the most challenging tasks in endocrinology. The first-line treatment, transsphenoidal pituitary surgery, is associated with a high failure rate and a high prevalence of recurrence. Re-operation is associated with an even higher rate of a failure and recurrence. There are three main second-line treatments for CD \u2013 pituitary radiation therapy (RT), bilateral adrenalectomy and chronic cortisol-lowering medical treatment. All these treatments have their limitations. While bilateral adrenalectomy provides permanent cure of the hypercortisolism in all patients, the unavoidable chronic adrenal insufficiency and the risk of development of Nelson syndrome are of concern. Chronic cortisol-lowering medical treatment is not efficient in all patients and side effects are often a limiting factor. RT is efficient for approximately two-thirds of all patients with CD. However, the high prevalence of pituitary insufficiency is of concern as well as potential optic nerve damage, development of cerebrovascular disease and secondary brain tumours. Thus, when it comes to decide appropriate treatment for patients with CD, who have either failed to achieve remission with pituitary surgery, or patients with recurrence, the pros and cons of all second-line treatment options must be considered.<\/jats:p>","DOI":"10.1530\/eje-19-0092","type":"journal-article","created":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T13:35:52Z","timestamp":1554384952000},"page":"D9-D18","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":27,"title":["Radiotherapy as a tool for the treatment of Cushing\u2019s disease"],"prefix":"10.1093","volume":"180","author":[{"given":"Frederic","family":"Castinetti","sequence":"first","affiliation":[{"name":"1Aix-Marseille Universit\u00e9, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Marseille Medical Genetics, Marseille, France"},{"name":"2Department of Endocrinology, Assistance Publique-H\u00f4pitaux de Marseille, H\u00f4pital de la Conception, Centre de R\u00e9f\u00e9rence des Maladies Rares de l\u2019hypophyse, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Brue","sequence":"additional","affiliation":[{"name":"1Aix-Marseille Universit\u00e9, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Marseille Medical Genetics, Marseille, France"},{"name":"2Department of Endocrinology, Assistance Publique-H\u00f4pitaux de Marseille, H\u00f4pital de la Conception, Centre de R\u00e9f\u00e9rence des Maladies Rares de l\u2019hypophyse, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskar","family":"Ragnarsson","sequence":"additional","affiliation":[{"name":"3Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"},{"name":"4Department of Endocrinology, Sahlgrenska University Hospital, G\u00f6teborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref301","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.wneu.2011.09.010","article-title":"Neurocognitive changes in pituitary adenoma patients after gamma knife radiosurgery: a preliminary study","volume":"78","year":"2012","journal-title":"World Neurosurgery"},{"key":"ref1411","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1111\/j.1365-2265.1990.tb03883.x","article-title":"Long-term follow-up of low-dose external pituitary irradiation for Cushing\u2019s disease","volume":"33","year":"1990","journal-title":"Clinical Endocrinology"},{"key":"ref431","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1365-2265.2011.04124.x","article-title":"Mortality and morbidity in Cushing\u2019s syndrome in New Zealand","volume":"75","year":"2011","journal-title":"Clinical Endocrinology"},{"key":"ref1271","first-page":"117","article-title":"Incidence and late prognosis of Cushing\u2019s syndrome: a population-based study","volume":"86","year":"2001","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref1181","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.wneu.2011.09.010","article-title":"Neurocognitive changes in pituitary adenoma patients after gamma knife radiosurgery: a preliminary study","volume":"78","year":"2012","journal-title":"World Neurosurgery"},{"key":"ref391","first-page":"117","article-title":"Incidence and late prognosis of Cushing\u2019s syndrome: a population-based study","volume":"86","year":"2001","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1210\/er.2013-1048","article-title":"The treatment of Cushing\u2019s disease","volume":"36","year":"2015","journal-title":"Endocrine Reviews"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s11102-014-0567-8","article-title":"Long-term remission and recurrence rate in a cohort of Cushing\u2019s disease: the need for long-term follow-up","volume":"18","year":"2015","journal-title":"Pituitary"},{"key":"ref711","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1530\/EJE-14-0144","article-title":"The incidence rate of pituitary adenomas in western Sweden for the period 2001\u20132011","volume":"171","year":"2014","journal-title":"European Journal of Endocrinology"},{"key":"ref1311","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/j.1365-2265.2011.04124.x","article-title":"Mortality and morbidity in Cushing\u2019s syndrome in New Zealand","volume":"75","year":"2011","journal-title":"Clinical Endocrinology"},{"key":"ref1561","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0140-6736(00)04006-X","article-title":"Association between premature mortality and hypopituitarism. 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