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Radiation and hypothalamic-pituitary function.

M D Littley, S M Shalet, C G Beardwell

    Bailliere'S Clinical Endocrinology and Metabolism
    |March 1, 1990
    PubMed
    Summary
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    Radiotherapy can cause insidious hypopituitarism (pituitary hormone deficiencies) in adults, requiring annual testing for at least 10 years. Early detection and treatment of these endocrine issues improve quality of life.

    Area of Science:

    • Endocrinology
    • Oncology
    • Radiation Oncology

    Background:

    • Hypopituitarism is a common, often delayed, consequence of radiotherapy for malignant diseases.
    • Clinical manifestations of pituitary deficiencies can be subtle and insidious, developing years post-treatment.
    • Patients receiving ≥20 Gy to the hypothalamic-pituitary axis are at risk, with higher doses and fraction sizes increasing risk.

    Purpose of the Study:

    • To highlight the risk of hypopituitarism following radiotherapy.
    • To emphasize the need for regular, long-term endocrine monitoring in at-risk patients.
    • To discuss the implications of radiotherapy on the hypothalamic-pituitary axis and anterior pituitary function.

    Main Methods:

    • Regular clinical assessment and dynamic testing of anterior pituitary hormone reserves (GH, ACTH, gonadotrophins, TSH).

    Related Experiment Videos

  • Annual testing recommended for at least 10 years post-radiotherapy or until deficiency is identified.
  • Monitoring of patients with direct pituitary damage (interstitial radiotherapy, heavy particle beams) and those undergoing whole body irradiation.

    • Main Results:

    • Deficiencies typically develop in the order of GH, gonadotrophins, ACTH, and TSH, but this sequence is not always predictable.
    • Earliest damage is often to the hypothalamus, but direct pituitary damage can also occur.
    • Long-term endocrine sequelae are significant, particularly in childhood cancer survivors, affecting growth, puberty, and thyroid function.

    Conclusions:

    • Comprehensive, long-term endocrine surveillance is crucial for patients treated with radiotherapy.
    • Early detection and management of hypopituitarism can significantly improve patients' quality of life.
    • Expert endocrine supervision is essential for managing complex endocrine dysfunction in pediatric cancer survivors.