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Previous Volume 328:87-94 January 14, 1993 Number 2 Next

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ABSTRACT

Background Patients with brain tumors who are treated with radiation frequently have growth hormone deficiency, but other neuroendocrine abnormalities are presumed to be uncommon.

Methods We studied endocrine function in 32 patients (age, 6 to 65 years) 2 to 13 years after they had received cranial radiotherapy for brain tumors. The doses of radiation to the hypothalamic-pituitary region ranged from 3960 to 7020 rad (39.6 to 70.2 Gy). Nine patients also received 1800 to 3960 rad (18.0 to 39.6 Gy) to the craniospinal axis. Serum concentrations of thyroid, gonadal, and pituitary hormones were measured at base line and after stimulation.

Results Nine patients (28 percent) had symptoms of thyroid deficiency, and 20 patients (62 percent) had low serum total or free thyroxine or total triiodothyronine concentrations. Of the 23 patients treated only with cranial radiation, 15 (65 percent) had hypothalamic or pituitary hypothyroidism. Of the nine patients who also received spinal (and thus direct thyroid) radiation, three (33 percent) had evidence of primary thyroid injury.

Seven of the 10 postpubertal, premenopausal women (70 percent) had oligomenorrhea, and 5 (50 percent) had low serum estradiol concentrations. Three of the 10 men (30 percent) had low serum testosterone concentrations. Overall, 14 of the 23 postpubertal patients (61 percent) had evidence of hypogonadism. Mild hyperprolactinemia was present in 50 percent of the patients. Responses to stimulation with corticotropin-releasing hormone and corticotropin were normal in all patients except one, who had panhypothalamic dysfunction. However, serum 11-deoxycortisol responses to the administration of metyrapone were low in 11 of the 31 patients (35 percent) tested.

Three of the 32 patients (9 percent) had no endocrine abnormalities, 9 (28 percent) had an abnormal result on tests of thyroid, gonadal, prolactin, or adrenal function, 8 (25 percent) had abnormalities in two axes, 8 (25 percent) in three axes, and 4 (12 percent) in all four axes.

Conclusions Cranial radiotherapy in children and adults with brain tumors frequently causes abnormal hypothalamic-pituitary function. The most frequent changes are hypothyroidism and gonadal dysfunction, although subtle abnormalities in adrenal function may also be present.

Source Information

From the Department of Radiation Oncology (L.S.C., P.R.), Pediatric Oncology Division, Department of Pediatrics (L.S.C.), Endocrinology Division, Department of Medicine (P.D.W.), and the Department of Biostatistics (R.F.R.), University of Rochester Medical Center, Rochester, N.Y.; the Department of Radiation Oncology, Dover General Hospital, Dover, N.J. (D.C.); and the Endocrinology Division, Department of Pediatrics, State University of New York Health Science Center, Syracuse (G.M., K.M.). Presented in part at the 33rd Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Washington, D.C., November 4-8, 1991.

Address reprint requests to Dr. Constine at the Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642-8647.

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