Pituitary Dysfunction Common in Adults After Cranial Radiotherapy

June 09, 2011

By Will Boggs MD

NEW YORK (Reuters Health) Jun 08 - Adults who have cranial radiotherapy for nonpituitary tumors commonly develop hypopituitarism, researchers from The Netherlands report.

"We hope to increase the awareness of hypopituitarism after cranial irradiation in adults, especially among oncologists, radiotherapists, neurologists, and otolaryngologists so that they will refer patients for regular check-ups and consider other diagnoses for fatigue than the malignancy," Dr. Natasha M. Appelman-Dijkstra from Leiden University Medical Center, The Netherlands told Reuters Health in an email.

Dr. Appelman-Dijkstra and colleagues conducted a systematic review and meta-analysis of 18 studies that reported prevalence of pituitary insufficiency after cranial or total body radiotherapy for intracerebral tumors, nasopharyngeal tumors, or hematological malignancies in 813 adults.

Their results appear in the May 25th online issue of The Journal of Clinical Endocrinology & Metabolism.

Nearly two-thirds of patients (66%) developed any pituitary deficiency. ACTH deficiency developed in 22%, TSH deficiency in 25%, LH/FSH deficiency in 30%, hyperprolactinemia in 34%, and growth hormone deficiency in 45%.

The prevalences of these deficiencies didn't differ significantly between patients with nasopharyngeal cancer and patients with intracerebral tumors.

Growth hormone deficiency developed a mean 2.6 years after radiotherapy, hyperprolactinemia or LH/FSH after about 3.8 years, ACTH insufficiency after 6 years, and TSH insufficiency after 11 years.

"Assessment of pituitary function should be included in the long-term follow-up of all cranially irradiated patients," the researchers conclude. "Taking into consideration the improved survival of patients, duration of follow-up for at least 15 years should be advisable."

"Depending on how the patients are doing, we think patients should be tested 6-12 months after their radiotherapy and then a yearly follow up," Dr. Appelman-Dijkstra said. "After probably 7-8 years the time interval can be larger, like once every 18-24 months."

"We are currently performing a study on long-term cancer survivors," Dr. Appelman-Dijkstra added.

SOURCE: http://bit.ly/mDHivi

J Clin Endocrinol Metab 2011.


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