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Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Late Effects of the Endocrine System

Table 8. Anterior Pituitary Hormones and Major Hypothalamic Regulatory Factors continued...

Adrenal-corticotropin deficiency

Adrenocorticotropic hormone (ACTH) deficiency is less common than other neuroendocrine deficits but should be suspected in patients who have a history of brain tumor (regardless of therapy modality), cranial irradiation, GH deficiency, or central hypothyroidism.[22,24,49,53,54,55,56] Although uncommon, ACTH deficiency can occur in patients who have received intracranial radiation that did not exceed 24 Gy and has been reported to occur in less than 3% of patients after chemotherapy alone.[56] Patients with partial ACTH deficiency may have only subtle symptoms unless they become ill. Illness can disrupt these patients' usual homeostasis and cause a more severe, prolonged, or complicated course than expected. As in complete ACTH deficiency, incomplete or unrecognized ACTH deficiency can be life-threatening during concurrent illness.

Hyperprolactinemia

Hyperprolactinemia has been described in patients who have received doses of radiation higher than 50 Gy to the hypothalamus or who have undergone surgery disrupting the integrity of the pituitary stalk. Hyperprolactinemia may result in delayed puberty. In adult women, hyperprolactinemia may cause galactorrhea, menstrual irregularities, loss of libido, hot flashes, infertility, and osteopenia; in adult men, impotence and loss of libido. Primary hypothyroidism may lead to hyperprolactinemia as a result of hyperplasia of thyrotrophs and lactotrophs, presumably due to TRH hypersecretion. The prolactin response to TRH is usually exaggerated in these patients.[22,24,53]

Table 9. Pituitary Gland Late Effects

Predisposing TherapyEndocrine/Metabolic EffectsHealth Screening
BMI = body mass index; FSH = follicle-stimulating hormone; LH = luteinizing hormone.
Radiation impacting hypothalamic-pituitary axisGrowth hormone deficiencyAssessment of nutritional status
Height, weight, BMI, Tanner stage
Radiation impacting hypothalamic-pituitary axisPrecocious pubertyHeight, weight, BMI, Tanner stage
Radiation impacting hypothalamic-pituitary axisGonadotropin deficiencyHistory: puberty, sexual function
Exam: Tanner stage
FSH, LH, estradiol or testosterone levels
Radiation impacting hypothalamic-pituitary axisCentral adrenal insufficiencyHistory: failure to thrive, anorexia, episodic dehydration, hypoglycemia, lethargy, unexplained hypotension
Endocrine consultation for those with radiation dose ≥30 Gy
Radiation impacting hypothalamic-pituitary axisHyperprolactinemiaHistory/exam: galactorrhea
Prolactin level
Radiation impacting hypothalamic-pituitary axisOverweight/obesity; metabolic syndromeHeight, weight, BMI
Blood pressure
Fasting blood glucose level and lipid profile
Radiation impacting hypothalamic-pituitary axisCentral hypothyroidismFree thyroxine (Free T4) level
1|2|3|4|5|6|7|8|9|10|11
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