Pituitary deficiency after brain radiation therapy in childhood

Abstract

Introduction: As part of an anticancer therapy, craniospinal radiotherapy causes variable degrees of hormonal deficiencies. The onset of hormonal deficiencies depends on the dose delivered to the pituitary –hypothalamic region while their incidence and severity depends on dose fractionating and follow up duration.
 Objectives: Analyzing the long –term endocrine complications in children treated with craniospinal radiotherapy.
 Material and methods: A prospective study; including 4 medical files collected over a period of 2 years.
 Results: The study includes 4 patients with a sex ratio of 3M/1F; and a mean age of 18, 62 years. The average age at the time of irradiation was 9, 12 years. The delay between the end of radiotherapy and the first consultation varied between 1 year and 21 years. The radiotherapy was administred for medulloblastoma (n=1), Burkitt lymphoma (n=1), cavum cancer (n=1), Posterior Cranial Fossa Tumor (n=1).
 The hormonal assessment revealed: a central hypothyroidism in 3 patients, corticotropin insufficiency in 2 cases, and gonadotropin deficiency associated with micropenis in one case. No cases of diabetes insipidus have been reported. Pituitary hypothalamic MRI objectified an atrophic anterior pituitary gland in two cases. Hormonal substitutive therapy was started in all patients. Recombined human GH treatment was introduced in one case, but omitted in two others cases for bad control of the cancerous disease and for an achieved puberty in the fourth patient.
 Conclusion: The search of the hormonal deficiencies is essential for any child treated by craniospinal radiotherapy in order to institute an early hormonal substitutive therapy.
 Keywords: Craniospinal radiotherapy, hormonal deficiencies, substitutive therapy