Abstract
BackgroundThe hypothalamic–pituitary (h-p) unit is a particularly radiosensitive region in the central nervous system. As a consequence, radiation-induced irreversible, progressively chronic onset hypopituitarism (RIH) commonly develops after radiation treatments and can result in variably impaired pituitary function, which is frequently associated with increased morbidity and mortality.Case presentationA 38-year-old male subject, previously having received radiotherapy for treatment of nasopharygeal carcinoma (NPCA) 16 years ago, appeared at OPD complaining about his failure in penile erection, loss of pubic hair, atrophy of external genitalia: testicles reduced to 2×1.5 cm; penile size shrunk to only 4 cm long. Characteristically, he showed extremely lowered human growth hormone, (HGH, 0.115 ng/mL), testosterone (<0.1 ng/mL), total thyroxine (tT4: 4.740 g/mL), free T4 (fT4, 0.410 ng/mL), cortisol (2.34 g/dL); lowered LH (1.37 mIU/mL) and estradiol (22 pg/mL); highly elevated TSH (7.12 IU/mL). As contrast, he had low end normal ACTH, FSH, total T3, free T3, and estriol; high end normal prolactin (11.71 ng/mL), distinctly implicating hypopituitarism-induced hypothyroidism and hypogonadism. serologically, he showed severely lowered Hb (10.6 g/dL), HCT (32.7%), MCV (77.6 fL), MCH (25.3 pg), MCHC (32.6 g/dL), and platelet count (139×103/L) with extraordinarily elevated RDW (18.2%), together with severely lowered ferritin (23.6 ng/mL) and serum iron levels; highly elevated total iron binding capacity (TIBC, 509 g/dL) and transferrin (363.4 mg/dL), suggesting microcytic anemia. Severely reduced estimated glomerular filtration rate (e-GFR) (89 mL/mim/1.73 m2) pointed to CKD2. Hypocortisolemia with hyponatremia indicated secondary adrenal insufficiency. Replacement therapy using androgen, cortisol, and Ringer’s solution has shown beneficial in improving life quality.ConclusionsTo our believe, we are the first group who report such complicate PTX dysfunction with adrenal cortisol insufficiency concomitantly occurring in a single patient.
Highlights
The hypothalamic–pituitary (h-p) unit is a radiosensitive region in the central nervous system
Life table analysis shows that the percent damages are dose- and timedependent, and the frequency of GH deficiency (GHD) can substantially increase to reach as high as 50–100% [3]
We report a male patient who showed apparently shrunken penis and reduced testicular size, erectile dysfunction and loss of libido 16 years post radiotherapy of his nasopharyngeal carcinoma (NPCA)
Summary
Damage resulting from radiotherapy is a progressive, chronic, and irreversible process. This case has taken 16 years to elicit PTX axis and adrenal dysfunction and concomitantly, secondary hypopituitarism complicated with second stage hypothyroidism, microcytic anemia, secondary hypocortisolemia with hyponatremia, secondary hypogonadism, and CKD2. We are the first group who report such a complicate PTX dysfunction which involves adrenal cortisol insufficiency, chronic kidney disease and microcytic anemia concomitantly in a single patient. Authors’ contributions YTL was responsible for concept, design, acquisition and interpretation of data. CCC and RYP contributed to design and critical revision of the manuscript and KCC was responsible for the critical revision of the manuscript. All authors have read and approved the final manuscript
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