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Effect of cancer treatment on hypothalamic-pituitary function
Elizabeth Crowne1, Helena Gleeson2, Helen Benghiat3
1Department of Paediatric Diabetes and Endocrinology, Bristol Royal Hospital for Children, Bristol, UK.
The Lancet. Diabetes & Endocrinology
|April 16, 2015
Summary
Cancer survivors face long-term endocrine risks, particularly hypopituitarism after cranial radiotherapy. Radiotherapy dose impacts hormone deficiencies, necessitating vigilant monitoring and management by oncologists and endocrinologists.
Area of Science:
- Endocrinology
- Oncology
- Radiation Oncology
Background:
- Improved cancer survival rates in children and young adults have increased focus on long-term treatment side effects.
- Cancer therapies, especially cranial radiotherapy, pose significant risks to the endocrine system, particularly the hypothalamic-pituitary axis.
- Long-term health issues, including hormone deficiencies, can manifest years after treatment completion.
Purpose of the Study:
- To review the long-term endocrine consequences of cancer treatment, focusing on hypopituitarism following cranial radiotherapy.
- To elucidate the relationship between radiotherapy dose and the development and severity of hormone deficiencies.
- To highlight the emerging endocrine risks associated with newer cancer therapies and emphasize collaborative care.
Main Methods:
- Review of existing literature on the endocrine sequelae of cancer treatment, with a focus on cranial radiotherapy.
- Analysis of the dose-dependent effects of radiotherapy on the hypothalamic-pituitary axis and subsequent hormone deficiencies.
- Discussion of the impact of cytotoxic drugs, glucocorticosteroids, and novel biological agents on endocrine function.
Main Results:
- Cranial radiotherapy frequently leads to hypothalamic-pituitary axis dysfunction, manifesting as hypopituitarism.
- Growth hormone deficiency is the most common, followed by deficiencies in gonadal, adrenal, and thyroid hormones.
- The severity and pattern of hypopituitarism are directly related to the radiotherapy dose, with higher doses (>60 Gy) leading to multiple hormone deficiencies.
Conclusions:
- Hypopituitarism is a significant long-term complication of cranial radiotherapy, impacting growth, puberty, general wellbeing, and fertility.
- Modern radiotherapy techniques aim to mitigate hypothalamic-pituitary axis damage by minimizing radiation dose.
- Oncologists and endocrinologists must collaborate to manage endocrine risks from conventional and novel cancer therapies, including autoimmune hypophysitis.
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