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Late Effects of the Neuroendocrine System

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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.[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 deficiencyAssessment 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 deficiencyHistory: puberty, sexual function
Exam: Tanner stage
FSH, LH, estradiol or testosterone levels
Radiation impacting hypothalamic-pituitary axis Central 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 axis Hyperprolactinemia History/exam: galactorrhea
Prolactin level
Radiation impacting hypothalamic-pituitary axis Overweight/obesity; metabolic syndromeHeight, weight, BMI
Blood pressure
Fasting blood glucose level and lipid profile
Radiation impacting hypothalamic-pituitary axis Central hypothyroidismFree 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.

References:

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Last Updated: May 16, 2012
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