Late Effects of the Neuroendocrine System
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.[2,4,32]
Table 11. Neuroendocrine Late Effects
BMI = body mass index; FSH = follicle-stimulating hormone; LH = luteinizing hormone.
|Predisposing Therapy|| Endocrine/Metabolic Effects ||Health Screening|
|Radiation impacting hypothalamic-pituitary axis ||Growth hormone deficiency||Assessment of nutritional status |
|Height, weight, BMI, Tanner stage |
|Radiation impacting hypothalamic-pituitary axis ||Precocious puberty ||Height, weight, BMI, Tanner stage|
|Radiation impacting hypothalamic-pituitary axis ||Gonadotropin deficiency||History: puberty, sexual function |
|Exam: Tanner stage|
|FSH, LH, estradiol or testosterone levels|
|Radiation impacting hypothalamic-pituitary axis ||Central adrenal insufficiency||History: failure to thrive, anorexia, episodic dehydration, hypoglycemia, lethargy, unexplained hypotension |
|Endocrine consultation for those with radiation dose ?30 Gy |
|Radiation impacting hypothalamic-pituitary axis ||Hyperprolactinemia ||History/exam: galactorrhea |
|Prolactin level |
|Radiation impacting hypothalamic-pituitary axis ||Overweight/obesity; metabolic syndrome||Height, weight, BMI |
|Fasting blood glucose level and lipid profile|
|Radiation impacting hypothalamic-pituitary axis ||Central hypothyroidism||Free thyroxine (Free T4) level|
Refer to the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers for neuroendocrine system late effects information including risk factors, evaluation, and health counseling.
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