CN-06 * IS HYPOPITUITARISM CLINICALLY RELEVANT IN GLIOMA PATIENTS? - A CROSS-SELECTIONAL TRIAL IN PATIENTS WITH HIGH-GRADE GLIOMAS

Abstract

BACKGROUND: The outcome of patients with malignant high-grade glioma (HGG) has improved significantly during the last decade. In most patients the radiation field includes parts of the hypothalamus and/or the pituitary gland, which may cause a complex pattern of neuroendocrine dysfunction. The objective to this cross-sectional study was to evaluate the prevalence of secondary and tertiary hypothyroidism in patients following standard therapy of HGG. METHODS: Serum concentrations of pituitary and peripheral thyroid and sexual hormones were measured in 258 subjects (122 female, 136 male) with HGG. All patients had been treated with standard radio-chemotherapy (radiation up to 60 Gy, followed by adjuvant chemotherapy with temozolomide) up to ten years before testing. RESULTS: TSH was reduced in 22% and increased in 18% of all cases (n = 258). Circulating fT4 and fT3 levels were lowered in 5% and 20%, but increased in 10% and 3%, respectively. With regards to the sexual hormones, we observed an interesting hormonal profile in men (n = 123). Pituitary hormones LH, FSH and prolactin were increased in 64%, 62% and 47% of all men. However, circulating testosterone levels were decreased in 40% of men ≤ 50 years and 16% of men > 50 years. In contrast, LH and FSH concentrations were below the lower reference limit in 75% of women > 50 years, but only in 6% of women ≤ 50 years. Serum progesterone and estrogen levels were lowered in 39% and 36% of women ≤ 50 years and in 43% and 0% of women > 50 years. Of note, 78% of women ≤ 50 years and 78% of women > 50 years featured increased circulating testosterone levels. CONCLUSIONS: Standard treatment for HGG results in multiple changes of the pituitary-endocrine axis. Expecially the finding on increased testosterone concentrations in women is striking and warrants further investigation.