Effect of cancer treatment on hypothalamic–pituitary function

Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects

“…A secondary form of autoimmune drug-related hypophysitis has been recently described and related to the treatment with cytotoxic T-lymphocyte-associated antigen-4 (CTLA4) blocking antibodies [115][116][117][118][119][120][121][122][123]. A recent review by Faje summarized the clinical presentation, treatment and biological insight of hypophysitis secondary to immunotherapy [124].…”

“…Among these, immune-targeted cancer therapyrelated hypophysitis has been recently recognized as an endocrine IRAE [124,125]. In fact, recent reports observed that patients developed LYH and other autoimmune diseases during the treatment with the CTLA-4-blocking agent ipulimumab, suggesting a possible correlation between CTLA4 and LYH [115][116][117][118][119][120][121][122][123][124]. It has been suggested that these blocking antibodies may act by depleting T-regulatory cells [120].…”

Fertility counseling and preservation: considerations for the pediatric endocrinologist

“…Recent data from the Childhood Cancer Survivor Study show that both male and female survivors have significantly higher rates of fertility problems than their healthy siblings (25). Given that up to half of childhood survivors will suffer a therapyrelated endocrinopathy, pediatric endocrinologists are frequently involved in their care and should be examining gonadal function and providing fertility counseling (26).…”

“…Both alkylating agents and total body irradiation are commonly used in preparative regimens prior to hematopoietic stem cell transplantation (HSCT), resulting in gonadal insufficiency in up to 70-90% survivors (30,31). Finally, CNS radiotherapy can affect the hypothalamic-pituitary axis and result in precocious or delayed puberty/secondary hypogonadism (26). While fertility counseling is now considered standard of care for all patients with a new oncology diagnosis (32), fertility related discussions in survivorship are inconsistent and inadequate; in addition to distress and uncertainty about potential infertility, survivors have reported unplanned pregnancies due to misconceptions about infertility (33,34).…”

Should survivors of childhood cancer or testicular cancer be screened for androgen deficiency?

“…For example, intracranial neoplasias invade the hypothalamus and/or pituitary and cause deficiencies of growth hormone, gonadotrophins, thyrotrophin or adrenocorticotrophin. Cranial radiation used to treat intracranial neoplasia is often associated with progressive hypopituitarism that may take years to develop into a clinically significant endocrinopathy . Neoplasias that destroy normal endocrine tissue outside of the brain may cause primary endocrinopathies.…”