Follow-up/Surveillance

Question 1

What is the most common toxicity of pituitary irradiation?

Answer 1

Hypopituitarism. Risk is ∼20% at 10 yrs post Tx (Brada et al., Clin Endocrinol 2002) with FSR or SRS. (Sheehan et al., J Neurosurg 2013)

Question 2

What is the RT TD 5/5 TD threshold for developing hypopituitarism?

Answer 2

The TD 5/5 is 40–45 Gy. GH levels ↓ 1st, then LH/FSH → TSH/ACTH.

Question 3

What are the main benefits of using SRS for pituitary adenomas?

Answer 3

Benefits of SRS include ↓ neurocognitive sequelae and possible preservation of normal pituitary function by reducing the dose to the hypothalamus (↑ risk of damage to the optic nerve/chiasm).

Question 4

What is the best way to assess the response to RT in GH-secreting tumors?

Answer 4

The response to RT can be assessed by monitoring IGF-1 levels.

Question 5

What hormone is the 1st to respond/decrease after RT?

Answer 5

GH is the 1st hormone to respond/decrease after RT.

Question 6

What is the operative mortality/complication rate after Sg?

Answer 6

Mortality: 1%–2%

Complication rate: 15%–20%

Question 7

What are the most common surgical complications after resection of pituitary tumors?

Answer 7

DI (6%) → hyponatremia and CSF leak

Question 8

Which pituitary pts/tumor types are prone to increased rates of 2nd malignancies after Tx with RT?

Answer 8

Men with GH-secreting pituitary adenomas tend to have increased rates of 2nd malignancies after RT. (Norberg L et al., Clin Endocrinol 2007)