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Pituitary dysfunction after cranial radiotherapy for brain tumor.
Julie Chapon1, Julien Berthillier2, Amna Klich3
1Fédération d'endocrinologie, centre de référence des maladies rares hypophysaires (HYPO), hôpital Louis-Pradel, Groupement Hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France.
Annales D'Endocrinologie
|March 8, 2025
Summary
Cranial radiotherapy for brain tumors can cause pituitary deficits in nearly half of patients within 10 years. ACTH deficiency is rare and not isolated, potentially simplifying post-treatment monitoring.
Area of Science:
- Endocrinology
- Oncology
- Radiation Oncology
Background:
- Cranial radiotherapy for extrapituitary brain tumors is an uncommon cause of acquired pituitary deficiency.
- Understanding the incidence, timing, and predictors of pituitary deficits post-radiotherapy is crucial for patient management.
Purpose of the Study:
- To evaluate the incidence and time of onset of pituitary deficits after cranial radiotherapy for extrapituitary brain tumors.
- To identify factors that predict the development of these hormonal deficiencies.
Main Methods:
- A retrospective cohort study of 246 patients treated between 2005 and 2021.
- Analysis included hormone testing, incidence rates with 95% confidence intervals, and deficit-free survival using the Kaplan-Meier method.
Main Results:
- 48.0% of patients developed at least one hormonal deficit by study's end (mean follow-up 10 years).
- Growth hormone (GH) and thyroid-stimulating hormone (TSH) deficits were most common; ACTH deficit was rare (4.9%) and never isolated.
- Higher pituitary gland D50 (dose to 50% of gland) was associated with increased risk of deficit (HR: 2.51).
Conclusions:
- Approximately half of patients experience pituitary deficits 10 years post-radiotherapy for extrapituitary brain tumors.
- ACTH deficiency is infrequent and always accompanied by other deficits, suggesting dynamic testing may not be routinely necessary if other deficits are absent.
