Another 2 cases with no clinical treatment had a neuroradiological diagnosis of radiation necrosis and were under observation. Figure 1 Typical MRI scan changes in ACTH adenoma. Coronal T1-weighted postcontrast MRI scan at left and right, Inhibitor Library ic50 obtained in Patient 1, a 30-year-old man who presented with ACTH adenomas and consistent headache

2 years before undergoing GKRS. An enhancing mass lesion is seen in the sella turcia with extension to bilateral internal carotid artery. Patient 1′s serum ACTH level was 381.6 pg/ml, and his blood pressure was over 180/120 mmHg. The patient was treated with MASEP GKRS, and MRI was performed for treatment planning. 26 Gy defined to the 50% isodose line is used to cover the full extent of the pituitary tumor in all three planes. Figure 2 Typical MRI scan changes in ACTH adenoma. No enhancing mass lesion is seen in the sella turcia under the T1-weighted postcontrast MRI scan performed 2 years after GKRS. Patient MK 8931 purchase 1′s clinical symptom did improve. His serum ACTH level came down to 40.4 pg/ml, and his MEK inhibitor blood pressure was controlled within 140/80 mmHg. Figure 3 Typical MRI scan changes in prolactinomas adenoma. Coronal T1-weighted postcontrast MRI scan at left and right, obtained in Patient 2, a 27-year-old woman

who presented with prolactinomas adenomas and amenorrhea-galactorrhea 4 years before undergoing MASEP GKRS. An asymmetrically enhancing mass lesion is seen in the sella turcia with extension to bilateral internal carotid artery. Patient 2′s serum prolactin level was 183.7 ng/ml. The patient was treated with MASEP GKRS twice because of the huge volume of the mass. The second MASEP GKRS was performed 1 year after the first one. The tumor was treated separately with the lower and upper part in order to protect the optic chiasma.

MRI was performed for treatment planning. 25 Gy defined to the 50% Low-density-lipoprotein receptor kinase isodose line is used to cover the lower part of the pituitary tumor in the first treatment, and 18 Gy defined to the 50% isodose line is used to cover the upper part of the pituitary tumor in the second time. Figure 4 Typical MRI scan changes in prolactinomas adenoma. An enhancing mass lesion is seen in the sella turcia under the T1-weighted postcontrast MRI scan performed 1 year after MASEP GKRS, but the volume of the mass had collapsed for more than 50%. Patient 2′s clinical symptom did improve. Her serum prolactin level came down to 14.5 ng/ml, and she got gestation and delivered a healthy baby recently. Figure 5 Typical MRI scan changes in GH adenoma. Coronal T1-weighted postcontrast MRI scan at upper left and right, obtained in Patient 3, a 33-year-old man who presented with GH adenomas and acromegaly 7 years before undergoing MASEP GKRS. (Figure 5) An enhancing mass lesion is seen in the sella turcia with extension into the left cavernous sinus. Patient 3′s serum growth hormone level was 497.3 ng/ml initially.