Prolactinoma and Other Head and Neck Tumors After Scalp Irradiation

Carlos A. Benbassat, MD, David Olchovsky, MD

Disclosures

South Med J. 2003;96(2) 

In This Article

Abstract and Introduction

Tumors of the thyroid and parathyroid glands may develop together or separately in patients who previously have been exposed to head and neck irradiation. Whether cranial irradiation confers an increased risk for pituitary adenoma remains unknown. We report the case of a 52-year-old woman who was treated during childhood for tinea capitis with scalp irradiation and later in life developed a prolactin-secreting tumor, a parathyroid adenoma, a benign thyroid lesion, and a basal cell carcinoma of the skin. She was treated successfully with bromocriptine and surgical removal of the parathyroid adenoma. Molecular analysis of the parathyroid tissue failed to demonstrate any abnormality of the multiple endocrine neoplasia Type 1 gene. This case report is the first to describe a prolactin-secreting tumor that developed in association with other endocrine neoplasia after head and neck irradiation. Our case suggests that multiple endocrine neoplasia may develop in a sporadic pattern after scalp irradiation.

The multiple endocrine neoplasia Type 1 (MEN-1) syndrome is characterized by the occurrence of parathyroid, endocrine pancreatic, and anterior pituitary tumors, and, to a lesser extent, other endocrine tumors (eg, carcinoid or adrenal tumors) in a single patient or in a familial context.[1] The diagnosis of MEN-1 is made, for the most part, on the basis of clinical criteria. Germline mutations in the MEN1 gene[2] are sought for objective assessment and confirmation of the clinical diagnosis. Somatic inactivating mutations and allelic loss targeting the MEN1 gene locus at 11q13 are indicative of the involvement of the MEN1 gene in the tumorigenic process of the relevant neoplasms.[3] The inclusion of thyroid adenomas as part of the MEN-1 syndrome is controversial. Thyroid adenoma is known to develop in approximately 5% of patients with MEN-1,[4] but compelling evidence for the involvement of the MEN1 gene in the pathogenesis of benign thyroid adenomas is lacking. Although head and neck irradiation is a known risk factor for head and neck tumors,[5,6,7,8,9] it is unknown whether it confers an increased risk of pituitary adenomas. We report the case of a patient who was treated with scalp irradiation for tinea capitis during childhood. Later in life, she developed benign tumors of the parathyroid and pituitary glands, along with a benign thyroid nodule and basal cell carcinoma of the skin.

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