Long-term effects of external radiation on the pituitary and thyroid glands

Fuks, Zvi; Glatstein, Eli; Marsa, Gerald W.; Bagshaw, Malcolm A.; Kaplan, Henry S.

doi:10.1002/1097-0142(197602)37:2+<1152::aid-cncr2820370826>3.0.co;2-t

Cited by 156 publications

(30 citation statements)

References 40 publications

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“…The site of the damage on the pituitary gland or the hypothalamus remains to be demonstrated. (J Clin Endocrinol Metab 54: 1164, 1982 S EVERAL groups (1)(2)(3)(4)(5)(6)(7)(8) as well as our own (9) have already reported on the incidence and severity of anterior pituitary deficiency after head and neck radiotherapy. To our knowledge, however, less data are available on pubertal development (3,6,10,11).…”

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Effect of Hypothalamic and Pituitary Irradiation on Pubertal Development in Children with Cranial Tumors

Rappaport

Brauner

Czernichow

et al. 1982

The Journal of Clinical Endocrinology & Metabolism

153

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The purpose of the present study was to report on gonadotropin function and puberty of a large group of children treated by cranial irradiation for cranial and neck tumors and medulloblastoma. Forty-five children of pubertal age were investigated. The mean interval time since radiation was 5 2/12 yr. Gonadotropin and gonadal function were evaluated by clinical criteria, plasma sex steroids, and plasma LH and FSH responses to LRH. Puberty was complete or progressing normally in 31 cases and was abnormal in 14 cases. Severe gonadotropin deficiency, with lack of or slow progression of puberty and decreased LH and FSH responsiveness to LRH, was observed in 5 cases; 2 of these had moderately elevated plasma PRL levels. Secondary amenorrhea or lack of pubertal progression was found in 5 other cases. GH deficiency was associated with gonadotropin deficiency in 9 of these 10 cases. Adrenal function, estimated by basal dehydroisoepiandrosterone, dehydroisoepiandrosterone sulfate, and estrone, was normal according to pubic hair stages. In conclusion, complete or partial gonadotropin deficiency can be the consequence of cranial irradiation in children receiving 6000 rads or less. It is usually associated with GH deficiency. The site of the damage on the pituitary gland or the hypothalamus remains to be demonstrated.

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confidence: 99%

Effect of Hypothalamic and Pituitary Irradiation on Pubertal Development in Children with Cranial Tumors

Rappaport

Brauner

Czernichow

et al. 1982

The Journal of Clinical Endocrinology & Metabolism

153

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“…Long-term follow up is needed to evaluate the consequences of irradiation, especially for endocrine function. 27 It is important for the mostly young patient population because deficiencies in growth hormone and gonadotrophins are not uncommon and are correctable. '2 These deficiencies may occur as a consequence of the tumor, surgery, irradiation, or a combination of these.…”

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confidence: 99%

Controversy in the management of optic nerve glioma

Weiss

Sagerman

King

et al. 1987

Cancer

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The records of 16 patients with optic nerve glioma treated between 1961 and 1984 were reviewed. All patients except two had extension of tumor beyond the chiasm to the hypothalamus, adjacent brain and/or along the posterior optic tract. Eleven of 16 cases were biopsy-proven, two patients had craniotomy and visual inspection but no biopsy was performed, and in two cases the biopsy was not diagnostic. Fourteen patients received radiation therapy, usually consisting of 50 Gy in 5 weeks (range 40-56 Gy), one patient was treated surgically and one with chemotherapy. With a follow-up of 1 to 20 years, 7 of the 14 patients irradiated are alive, three patients are dead of disease at 3, 6 and 9 years post-treatment, three were lost to follow-up at 1, 8, and 8 years, and one is dead of intercurrent disease at 5.5 years. Overall vision was improved in five patients and stable in seven following treatment. In two patients, vision could not be evaluated because of young age at presentation. Four patients had recurrences. One was retreated with 30 Gy in 3 weeks and shows no evidence of disease at 20 years. The three other patients died of their disease. There is controversy over the best treatment for these patients. Based on these results and a review of the literature, the authors recommendation is to irradiate tumors with extension beyond the chiasm at the time of presentation rather than waiting for increasing symptoms because function that is lost may not always be recovered. Chemotherapy needs to be further investigated but holds promise, especially for the younger children.

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“…Esta resistência da secreção do TSH também é encontrada em lesões fora do eixo HH 1,^8,12,19 ou após radioterapia profilática para leucemia 5. O comprometimento da secreção tireoidiana pode, todavia, ser evento tardio e só se tornar aparente anos mais tarde 8,11. Se a radioterapia é dirigida à coluna cervical e, consequentemente, à tireóide para terapêutica complementar em alguns tipos de tumores, correm estes pacientes até risco de desenvolver hipotireiodismo primário 7,10,11,15. A presença 4e hiperprolactinemia em alguns destes pacientes é um dado adicional de que o hipotálamo pode estar comprometido.…”

Section: Alguns Pacientes Em Coma Prolongado Podem Apresentar Respostunclassified

Efeitos tardios na função hipotálamo-hipófise após tratamento de tumores parasselares

Motta

Martinelli

Abrahão³

et al. 1991

Arq. Neuro-Psiquiatr.

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RESUMO -O acompanhamento a longo prazo de pacientes submetidos a tratamento de tumores da região parasselar é importante para detectar complicações tardias da terapêutica. Neste estudo avaliamos 6 pacientes com craniofaringioma, 1 com meningioma, 1 com germi¬ noma e 1 com cisto epidermóíde, localizados na região parasselar. Eles haviam sido tratados, em média, 3,8±3,2 anos antes, por cirurgia e radioterapia (6 casos) ou somente cirurgia (3 casos). Cinco pacientes eram do sexo feminino e a média de idade era de 24,3±18,8 anos. A avaliação consistiu na infusão endovenosa de TRH (200 mg), GnRH (100 mg) e insulina regular (0,1 UI Kg/peso), bem como na dosagem dos hormônios hipofisários antes (0) e após 20, 40, 60 e 80 minutos. Encontramos os seguintes resultados: (a) resposta deficitária do GH e do cortisol era todos pacientes; (b) 7/9 pacientes não tiveram respostas adequadas do FSH e 3/9 do L.H; (c) 4/9 tiveram respostas inadequadas da prolactina e 2/8 do TSH. Concluimos que: (a) o déficit de GH e cortisol são os mais frequentes nestes pacientes; (b) a lesão após radioterapia pode localizar-se tanto no hipotálamo quanto na hipófise ou, ainda, em ambos; (c) a sensibilidade das células hipofisárias e hipotalâmicas à irradiação é diferente de acordo com os hormônios que produzem; (d) é necessário o acompanhamento endocrinológico frequente dos pacientes submetidos a tratamento de tumores parasselares, a fim de detectar déficits hormonais tardios. SUMMARY -Long term follow-up of patients submitted to treatment of paraselar tumours region is important for the detection of late therapeutic complications. In this study the authors conducted an evaluation of six patients with craniopharyngioma, one with germinoma, one with meningioma, and one epidermoid cyst. All above tumours were localized at paraselar region. Six out of nine patients had been treated both by surgery and by radiotherapy and the other three surgically only, on an average 3.8±3.2 years before this observation was carried out. Five patients were female with their ages average 24.3±18.8 years old. Evaluation consisted: in the first place, an intravenous infusion of thyrotropin-releasing hormone (TRH, 200 mg), gonadotropin-releasing hormone (GnRH, 100 mg), and insulin tolerance test (0,1 IU/Kg, regular insulin); and secondly, in measurements of pituitary hormones secretion at different time points -0, 20,40, 60 and 80 minutes. We found both diminished response of growth hormone and Cortisol in all the patients. Seven out of nine patients did not have adequate response to follicle-stimulating hormone.Three out of nine responded unsatisfactory to luteinizing hormone. Four out of nine showed inadequate responses to prolactin as well as, two out of eight to thyrotropin.We concluded that: (a) growth hormone and Cortisol deficiency are the most frequent finding in these patients; (b) post-radiotherapy lesions can be located in the hypothalamus or pituitary, or even in Trabalho realizado na

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Long-term effects of external radiation on the pituitary and thyroid glands

Cited by 156 publications

References 40 publications

Effect of Hypothalamic and Pituitary Irradiation on Pubertal Development in Children with Cranial Tumors

Effect of Hypothalamic and Pituitary Irradiation on Pubertal Development in Children with Cranial Tumors

Controversy in the management of optic nerve glioma

Efeitos tardios na função hipotálamo-hipófise após tratamento de tumores parasselares

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