In this research, we observed similar result in our patients with radiosurgery as the major treatment. As most patients with prolactinomas

can be adequately controlled by medical treatment. Gamma knife radiosurgery has been used by us in only few patients. It may be a suitable alternative in patients who experience side effects of dopaminergic drugs or in patients with tumor extension to the cavernous sinuses. The largest series of prolactinomas treated with GKRS was reported by Pan et al[23]. Their study used normal serum prolactin level for gender as cure criteria, and they reported a 15% endocrinological remission rate achieved for 128 patients with a median follow-up of 33 months. Some studies utilize relatively similar criteria. ‘Cure’rates varied from 20 to 84%. In our study, we achieved better tumor growth control than endocrinological control without the use of medical therapies after radiosurgery, S63845 concentration and the usage of medical therapies after radiosurgery still needed further evaluation. Pan et al suggested that dopaminergic drugs seemed to induce radioprotection[23]. In our unit, MASEP GKRS were performed during an intermission in drug therapy when the drug therapy is discontinued.

The PCI-34051 in vitro criteria for controlling acromegaly have still been inconsistent. The most widely accepted guidelines for a remission in acromegaly consist of a GH level less than 1 ng/ml in response to a glucose challenge and a normal serum IGF-1 when matched for age and gender. Some studies with such criteria detail the results of GKRS for patients with acromegaly. The mean radiosurgery margin doses

find more in these series ranged from 15 to 34 Gy. ‘Cure’rates following radiosurgery varied from 0 to 100%. In these series with at least 16 patients and a median follow-up of 2 years, endocrinological remission rates ranged from 20 to 96%[24, 25]. Our study found similar results with longer follow-up. The high incidence of hypopituitarism is one of the significant shortcomings of conventional radiotherapy[26]. It can develop many years after irradiation. The data available are varied, depending on the length of follow-up. Tsang reported more than 22% of patients developing hypopituitarism during the 10 years after conventional PRKD3 irradiation[27]. Salinger reported 37% of patients developing hypopituitarism, within a follow-up of 5 years[28]. Stereotactic targeting, allowed by GKRS, should lower the incidence of hypopituitarism. However, the incidence of hypopituitarism after GKRS is difficult to determine at present. Reports in the literature for the incidence of post-radiosurgery hypopituitarism vary widely. Well respected groups have reported a low incidence (0~36%) of pituitary dysfunction following radiosurgery[29]. A long term study from the Karolinska Institute with a mean follow-up of 7 years, however, reported an eventual 42% incidence of hypopituitarism[30].