Background Patients with brain tumors who are treated with radiationfrequently have growth hormone deficiency, but other neuroendocrineabnormalities are presumed to be uncommon.
Methods We studied endocrine function in 32 patients (age, 6to 65 years) 2 to 13 years after they had received cranial radiotherapyfor brain tumors. The doses of radiation to the hypothalamic-pituitaryregion ranged from 3960 to 7020 rad (39.6 to 70.2 Gy). Ninepatients also received 1800 to 3960 rad (18.0 to 39.6 Gy) tothe craniospinal axis. Serum concentrations of thyroid, gonadal,and pituitary hormones were measured at base line and afterstimulation.
Results Nine patients (28 percent) had symptoms of thyroid deficiency,and 20 patients (62 percent) had low serum total or free thyroxineor total triiodothyronine concentrations. Of the 23 patientstreated only with cranial radiation, 15 (65 percent) had hypothalamicor pituitary hypothyroidism. Of the nine patients who also receivedspinal (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 estradiolconcentrations. Three of the 10 men (30 percent) had low serumtestosterone concentrations. Overall, 14 of the 23 postpubertalpatients (61 percent) had evidence of hypogonadism. Mild hyperprolactinemiawas present in 50 percent of the patients. Responses to stimulationwith corticotropin-releasing hormone and corticotropin werenormal in all patients except one, who had panhypothalamic dysfunction.However, serum 11-deoxycortisol responses to the administrationof 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 abnormalitiesin two axes, 8 (25 percent) in three axes, and 4 (12 percent)in all four axes.
Conclusions Cranial radiotherapy in children and adults withbrain tumors frequently causes abnormal hypothalamic-pituitaryfunction. The most frequent changes are hypothyroidism and gonadaldysfunction, although subtle abnormalities in adrenal functionmay 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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