Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Clin Endocrinol (Oxf). 2019 Jul;91(1):131-140. doi: 10.1111/cen.13971. Epub 2019 Apr 16.
Childhood brain tumour survivors who receive cranial radiotherapy undergo regular surveillance for the development ofhypothalamic-pituitary (HP) axis dysfunction. Much less attention has been given to radiation-induced hypopituitarism in patients with malignant brain tumours of adult onset.
Retrospective cohort study.
PATIENTS/MEASUREMENTS: We assessed the effects of cranial radiotherapy (cXRT) on pituitary function in 58 adults (32 male) with gliomas distant to the HP axis. The XRT dose exposure at the HP axis was correlated with individual axis dysfunction to establish dose thresholds.
Mean age at cXRT was 41.2 ± 10.9 years and duration of endocrine follow-up 8.2 ± 5.2 years. Mean XRT dose to the HP axis was 35.9 ± 15.5 Gy. Overall prevalence of radiation-induced hypopituitarism was 84.5%. GH, LH/FSH, ACTH and TSH deficiency were present in 82.8%, 20.7%, 19% and 6.9% of patients, respectively. Hyperprolactinaemia was noted in 10.3% (n = 6) and was persistent in one case. GH deficiency and "any degree of hypopituitarism" positively correlated with the radiotherapy dose to the hypothalamic-pituitary axis. HP axis XRT dose thresholds for the development of GHD, LH/FSH, ACTH and TSH deficiency were established at 10, 30, 32 and 40.8 Gy, respectively. A gradual increase in the prevalence of all anterior pituitary hormone deficits was observed throughout the follow-up period.
Hypopituitarism post-cXRT in adults with gliomas is a frequent, progressive and dose-dependent phenomenon. Dose thresholds suggest long-term endocrine surveillance is important where the HP axis XRT dose is higher than 30 Gy. Identification of deficits to allow early and appropriate hormone replacement therapy is important to improve well-being in these individuals with limited prognosis.
接受颅放射治疗的儿童脑肿瘤幸存者需要定期监测下丘脑-垂体（HP）轴功能障碍的发展。对于成人发病的恶性脑瘤患者，辐射引起的垂体功能减退症则关注较少。
回顾性队列研究。
患者/测量指标：我们评估了颅放射治疗（cXRT）对 58 例远离 HP 轴的胶质瘤成人患者垂体功能的影响。HP 轴的 XRT 剂量暴露与个别轴功能障碍相关，以确定剂量阈值。
cXRT 时的平均年龄为 41.2±10.9 岁，内分泌随访时间为 8.2±5.2 年。HP 轴的平均 XRT 剂量为 35.9±15.5Gy。总体上，辐射诱导的垂体功能减退症的患病率为 84.5%。GH、LH/FSH、ACTH 和 TSH 缺乏分别见于 82.8%、20.7%、19%和 6.9%的患者。催乳素血症发生率为 10.3%（n=6），其中 1 例持续存在。GH 缺乏和“任何程度的垂体功能减退症”与 HP 轴的放射治疗剂量呈正相关。GH 缺乏症和 LH/FSH、ACTH 和 TSH 缺乏的 HP 轴 XRT 剂量阈值分别确定为 10、30、32 和 40.8Gy。在整个随访期间，所有前垂体激素缺乏症的患病率均逐渐增加。
cXRT 后成人胶质瘤患者的垂体功能减退症是一种常见的、进行性的、剂量依赖性的现象。剂量阈值表明，在 HP 轴 XRT 剂量高于 30Gy 的情况下，长期进行内分泌监测非常重要。确定缺陷以允许早期和适当的激素替代治疗对于改善这些预后有限的个体的幸福感非常重要。
