Radiation Necrosis of the Brain in Acromegaly

ADIATION necrosis of the brain is a rare but serious complication of the treatment of acromegaly. This report describes 3 cases, each from a different institution, in which large doses of external irradiation produced significant delayed destructive lesions of cerebral tissue. In each case, craniotomy was necessary, in one bilaterally, for the removal of necrotic gliomatous masses. To our knowledge, no similar cases have been published, although reports of radiation damage and malignant changes in brain and spinal cord in other conditions 5,9,11, 17,1s.2l have occasionally been recorded. The large amounts of irradiation used probably do not reflect upon the institutions involved, but attest to the difficulty of control of acromegaly by non-surgical means in certain instances. 1~176 Until recently, factors have prejudiced such control. 1. Satisfactory measurement of human growth hormone activity has been unavailable, and except for the serum phosphorus level, other laboratory data are unreliable. Furthermore, clinical evaluation of the patient, or estimation of acral volume, are inexact criteria of activity. ~. Beneficial effects of irradiation are difficult to assess since they are gradual, often transitory and incomplete, sometimes leading to repeated courses of treatment. At the present time, with modern radio-immuno-assay measurements of human growth hormone,3.6-s.12.1s,57 and the remarkable safety and rapid effectiveness of total surgical hypophysectomy, 22,23 the control of acromegaly can be more accurate. The serious complications of radiation therapy described in these 3 cases can be avoided.