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Hypothalamic dysfunction following whole-brain irradiation.

J I Mechanick, F H Hochberg, A LaRocque

    Journal of Neurosurgery
    |October 1, 1986
    PubMed
    Summary
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    Whole-brain radiation therapy for brain tumors can cause subtle hypothalamic dysfunction, leading to endocrine, behavioral, and cognitive issues years later. This damage occurs independently of radiation necrosis or tumor invasion.

    Area of Science:

    • Neurology
    • Endocrinology
    • Oncology

    Background:

    • Primary glial neoplasms are often treated with megavoltage whole-brain x-irradiation.
    • Long-term effects of radiation on the central nervous system, particularly the hypothalamus, require further investigation.

    Purpose of the Study:

    • To investigate the incidence and clinical manifestations of hypothalamic dysfunction following whole-brain radiation therapy for primary glial neoplasms.
    • To differentiate radiation-induced hypothalamic damage from tumor recurrence or radiation necrosis.

    Main Methods:

    • Retrospective analysis of 15 patients treated with 4000-5000 rads of whole-brain irradiation.
    • Clinical assessment of endocrine, behavioral, and cognitive functions.
    • Hormonal assays (prolactin, thyrotropin-releasing hormone response).

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  • Neuroimaging (computerized tomography) to evaluate for radiation necrosis, tumor invasion, and structural changes.

    • Main Results:

    • Hypothalamic dysfunction was observed in 15 patients 2-9 years post-irradiation.
    • Symptoms included personality, libido, thirst, appetite, and sleep disturbances.
    • Hyperprolactinemia was present in all tested patients (9/9).
    • Cognitive abnormalities were noted in 7 patients.
    • Neuroimaging showed no hypothalamic tumor or necrosis, but cortical atrophy and third ventricular dilatation were common.

    Conclusions:

    • Hypothalamic dysfunction is a common and subtle long-term consequence of whole-brain radiation therapy for primary glial neoplasms.
    • Endocrine, behavioral, and cognitive impairments can herald this radiation-induced damage.
    • Early recognition and management of hypothalamic dysfunction are crucial in patients treated with cranial irradiation.