Partial Pituitary Ablation with Implants of Gold-198 and Yttrium-90 for Cushing's Syndrome with Associated Adrenal Hyperplasia

Abstract

Twenty cases of Cushing's syndrome due to bilateral adrenal hyperplasia have been treated by partial pituitary ablation, using needle implantation of radioactive gold or yttrium seeds, singly or in combination. The results of urinary 1 7-oxogenic steroid measurements during dexamethasone and Metopirone (metyrapone) tests before and after operation are described, and their value in demonstrating pituitary-dependence before implant, and in assessing the remission afterwards, is discussed. Of 14 patients without obvious pituitary tumours the response to first implant was satisfactory in eight, and there was a partial response in four. Of the six patients with obvious pituitary tumours four showed a partial response. There was no evidence of hypopituitarism after operation, apart from one patient who developed amenorrhoea. Complications were mainly in the patients with obvious pituitary tumours, where three patients developed cerebrospinal-fluid leak, in two after a second implant; in the other 13 cases there was one C.S.F. leak due to an anatomical anomaly. There was also one instance of visual damage due to operative misplacement. © 1965, British Medical Journal Publishing Group. All rights reserved.