Brauner R
Service d'Endocrinologie Pédiatrique, Université Paris V, Faculté et Hôpital Necker-Enfants Malades.
Ann Endocrinol (Paris). 1995;56(2):127-31.
Cranial irradiation may result in altered hypothalamo-pituitary function in patients treated for cancer distant from this area. Growth hormone (GH) deficiency is the most frequent complication. The frequency, delay of occurrence and severity of GH deficiency depend on the irradiation dose delivered to this area. The other factors influencing the frequency are the age at irradiation and the fractionation schedule. The frequency of other hypothalamo-pituitary changes is also dose-dependent: thyrotropin and gonadotropin deficiencies occur in 50-60% of cases after 50 Gray, and corticotrophin deficiency in 30%. Low dose cranial irradiation may also induce precocious puberty (onset < 8 yr in girls and < 10 yr in boys). The radiation-induced lesions seem to occur in the hypothalamus rather than in the pituitary. There is generally a good correlation between the GH peak and the growth velocity, but there may be normal growth in spite of GH deficiency after low dose or due to precocious puberty, decreased growth velocity in spite of normal GH peak, due to bone irradiation. Results on final height have been optimized by a better indication of GH therapy and by its association with treatment of precocious puberty.
对于远离该区域的癌症患者进行头颅照射可能会导致下丘脑 - 垂体功能改变。生长激素（GH）缺乏是最常见的并发症。GH缺乏的发生率、出现延迟及严重程度取决于该区域所接受的照射剂量。影响发生率的其他因素包括照射时的年龄和分次照射方案。其他下丘脑 - 垂体变化的发生率也与剂量相关：50 Gray照射后，促甲状腺激素和促性腺激素缺乏在50 - 60%的病例中出现，促肾上腺皮质激素缺乏在30%的病例中出现。低剂量头颅照射也可能诱发性早熟（女孩发病年龄<8岁，男孩<10岁）。辐射诱发的损伤似乎发生在下丘脑而非垂体。一般来说，GH峰值与生长速度之间有良好的相关性，但低剂量照射后尽管存在GH缺乏仍可能有正常生长，或者由于性早熟、骨骼照射导致尽管GH峰值正常但生长速度减慢。通过更好地掌握GH治疗指征及其与性早熟治疗相结合，最终身高的结果已得到优化。
