Biomedical subjects
Publications and source records attributed to L E Kirpatovskaia.
Method of dermal adrenal hyperfunctional suppression under CT-control in Itsenko-Cushing disease has been offered. Studies in the laboratory and in the clinic have revealed that this method is a method of choice in treatment of mild and middle forms of Itsenko-Cushing disease.
The authors represent the results of the treatment of 20 children with Itsenko-Cushing disease (ICD) by proton-beam irradiation of the pituitary body. The use of the medical proton beam of the Institute of Theoretical and Experimental Physics was found to be effective for the treatment of children with mild and average forms of ICD. Irradiation of the pituitary gland at a dose of 70-100 Gy is accompanied by general and local radiation reactions which are not dangerous for children. The time of development of remission after irradiation depends on a degree of severity and features of a course of disease.
The application of protons (heavy charged particles) for irradiation of the pituitary body has some essential advantages over other types of teletherapy: insignificant destruction of surrounding tissues, a possibility of a single therapeutic session as well as the absence of post-radiation effects. Proton beam therapy was given to 98 patients with Icenko-Cushing disease aged 15 to 40. Mild cases were treated by proton beam irradiation only while severe cases were managed using proton beam therapy combined with unilateral adrenalectomy or oral administration of ortho-para-DDD. Catamnesis duration varied from 3 to 5 years. In most cases the exposure dose was 80-90 Gy (50-110 Gy). The procedure was well tolerated by all the patients. A dynamic multipolar converting method with 15-20 entrance poles in the left temporal area was employed (with the beam energy of 200 MeV). Stabilization of the course of disease and some clinical improvement were observed in most of the patients 3-4 months after proton beam therapy. In 6-36 months after irradiation 90% of the patients showed normal biochemical indices and the absence of any clinical signs of the disease. Three-five years after treatment, 94% of the patients were in steady remission. A 24-hour ACTH and cortisol normalization pattern was observed in all the patients in parallel with an increase in GH and gonadotropin secretion and a decrease in the prolactin level. Sex function renewal appeared to be the first clinical sign of remission. Young patients aged 15 to 20 with a short duration of disease reached remission faster than patients of the other age groups. Thus the results of proton beam therapy of 98 patients with Icenko-Cushing disease after a follow-up of 3-5 years showed a high efficacy of this type of treatment. The method can be used alone or in combination with unilateral adrenalectomy as well as with oral administration of ortho-para-DDD.
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The authors present the results of proton therapy in 59 patients with different hypophyseal adenomas. The period of observation lasted from 6 mos. to 5 yrs. Irradiation was done using a multifield-convergent method and a proton beam of the ITEF synchrotron. The beam energy was 200 MeV, the beam diameter 7-15mm. Radiation response and immediate results were evaluated for all the patients. The least favorable results were noted in the patients with prolactinomas, for which, in addition to irradiation, parlodel therapy is needed. No marked radiation reactions, neurological complications and manifestations of hypopituitarism were observed with the chosen doses and schemes of irradiation.
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Altogether 25 patients with acromegaly, 19 patients with prolactinomas, and 6 patients with nonfunctioning hypophyseal tumors (NHT) were investigated. Dopaminergic regulation of PRL, STH, TSH, LH and FSH was investigated with sulpiride (an antagonist of peripheral action) in all the patients. In acromegaly, irrespective of the presence of hyperprolactinemia, one can observe dysfunction of the central dopaminergic system (DAE) and DAE-regulation of adenohypophyseal hormones. Signs of disordered hormonal DAE-regulation are disorder of the normal ejection of PRL and pathological ejection of TSH in response to administration of DA antagonists. The results of investigations revealed both an enhanced tone of the DAE-system and insufficiency of DAE-control of hormonal secretion in patients with different hypophyseal tumors and other neuroendocrine diseases.
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The investigation of 26 acromegalic patients long after irradiation of the pituitary body with a proton beam showed clinical and hormonal improvement in 38% of the patients, clinical improvement without complete growth hormone normalization in 46%, and the absence of any effect in 15%. The latter was mainly a result of partial irradiation of pituitary adenoma. Some patients after proton irradiation demonstrated signs of adenohypophyseal functional insufficiency, more marked in patients with a decreased level of Gy (over 5 ng/ml). A conclusion is that proton beam therapy is effective (provided all criteria for patients' eligibility are observed) and can be used as an independent method for the treatment of acromegalic patients.
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The results of non-contrast craniography in the diagnosis of small hypophyseal tumors are analysed. It was shown, that non-contrast craniography, i.e. ordinary craniography, radiography with the enlarged image, stereography and particularly tomography, is a safe method for diagnosing small intrasellar hypophyseal tumors. Radiodiagnosis of small intrasellar hypophyseal tumors is based on the determination of the pituitary fossa size and a detailed study of its state (structure, thickness, bicontour shape, disorder extent). To exclude hypophyseal microadenoma dynamic radiography is indicated every 6 months during 3 years to the patients with endocrine abnormalities, when the pituitary fossa size is within the upper limits of normal, provided the pituitary fossa walls are not affected.