Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: A report from the St Jude Lifetime Cohort Study Journal Article


Authors: Chemaitilly, W.; Li, Z.; Huang, S.; Ness, K. K.; Clark, K. L.; Green, D. M.; Barnes, N.; Armstrong, G. T.; Krasin, M. J.; Srivastava, D. K.; Pui, C. H.; Merchant, T. E.; Kun, L. E.; Gajjar, A.; Hudson, M. M.; Robison, L. L.; Sklar, C. A.
Article Title: Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: A report from the St Jude Lifetime Cohort Study
Abstract: Purpose: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. Patients and Methods: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. Results: The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. Conclusion: Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.
Keywords: childhood cancer; cancer survivor; hypopituitarism; cranial radiotherapy
Journal Title: Journal of Clinical Oncology
Volume: 33
Issue: 5
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2015-02-10
Start Page: 492
End Page: 500
Language: English
DOI: 10.1200/jco.2014.56.7933
PROVIDER: scopus
PMCID: PMC4314596
PUBMED: 25559807
DOI/URL:
Notes: Export Date: 2 March 2015 -- Source: Scopus
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  1. Charles A Sklar
    322 Sklar