HYPOTHALAMIC PITUITARY DYSFUNCTION AFTER RADIATION FOR BRAIN-TUMORS
HYPOTHALAMIC PITUITARY DYSFUNCTION AFTER RADIATION FOR BRAIN-TUMORS
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DOI：
10.1056/nejm199301143280203
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发表时间：
1993-01-14
影响因子：
158.5
通讯作者：
RUBIN, P
中科院分区：
文献类型：
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作者：
CONSTINE, LS;WOOLF, PD;RUBIN, P
背景。接受放射治疗的脑肿瘤患者通常有生长激素缺乏，但其他神经内分泌异常被认为是罕见的。我们研究了32例接受脑肿瘤放射治疗2 - 13年后的内分泌功能（年龄6 - 65岁）。下丘脑-垂体区的辐射剂量为3960 ~ 7020 rad （39.6 ~ 70.2 Gy）。9例患者接受1800 ~ 3960 rad （18.0 ~ 39.6 Gy）颅脊髓轴照射。在基线和刺激后测定血清中甲状腺、性腺和垂体激素的浓度。9名患者（28%）有甲状腺缺乏症状，20名患者（62%）血清总甲状腺素或游离甲状腺素或总三碘甲状腺原氨酸浓度低。在仅接受颅脑放射治疗的23例患者中，15例（65%）患有下丘脑或垂体甲状腺功能减退症。在9名同时接受脊柱（因此直接甲状腺）放射治疗的患者中，有3名（33%）有原发性甲状腺损伤的证据。10名青春期后、绝经前妇女中有7名（70%）有月经稀少，5名（50%）血清雌二醇浓度低。10名男性中有3名（30%）血清睾酮浓度较低。总的来说，23名青春期后患者中有14名（61%）有性腺功能减退的证据。50%的患者出现轻度高泌乳素血症。所有患者对促肾上腺皮质激素释放激素和促肾上腺皮质激素刺激的反应均正常，但有一名患者患有全下丘脑功能障碍。然而，在测试的31名患者中，有11名（35%）患者的血清11-脱氧皮质醇对美替拉酮的反应较低。32例患者中有3例（9%）没有内分泌异常，9例（28%）甲状腺、性腺、催乳素或肾上腺功能检查结果异常，8例（25%）两轴异常，8例（25%）三轴异常，4例（12%）四轴均异常。儿童和成人脑肿瘤患者的颅脑放疗常引起下丘脑-垂体功能异常。最常见的变化是甲状腺功能减退和性腺功能障碍，尽管肾上腺功能也可能存在细微的异常。
Background. Patients with brain tumors who are treated with radiation frequently have growth hormone deficiency, but other neuroendocrine abnormalities are presumed to be uncommon.Methods. We studied endocrine function in 32 patients (age, 6 to 65 years) 2 to 13 years after they had received cranial radiotherapy for brain tumors. The doses of radiation to the hypothalamic-pituitary region ranged from 3960 to 7020 rad (39.6 to 70.2 Gy). Nine patients also received 1800 to 3960 rad (18.0 to 39.6 Gy) to the craniospinal axis. Serum concentrations of thyroid, gonadal, and pituitary hormones were measured at base line and after stimulation.Results. Nine patients (28 percent) had symptoms of thyroid deficiency, and 20 patients (62 percent) had low serum total or free thyroxine or total triiodothyronine concentrations. Of the 23 patients treated only with cranial radiation, 15 (65 percent) had hypothalamic or pituitary hypothyroidism. Of the nine patients who also received spinal (and thus direct thyroid) radiation, three (33 percent) had evidence of primary thyroid injury.Seven of the 10 postpubertal, premenopausal women (70 percent) had oligomenorrhea, and 5 (50 percent) had low serum estradiol concentrations. Three of the 10 men (30 percent) had low serum testosterone concentrations. Overall, 14 of the 23 postpubertal patients (61 percent) had evidence of hypogonadism. Mild hyperprolactinemia was present in 50 percent of the patients. Responses to stimulation with corticotropin-releasing hormone and corticotropin were normal in all patients except one, who had panhypothalamic dysfunction. However, serum 11-deoxycortisol responses to the administration of metyrapone were low in 11 of the 31 patients (35 percent) tested.Three of the 32 patients (9 percent) had no endocrine abnormalities, 9 (28 percent) had an abnormal result on tests of thyroid, gonadal, prolactin, or adrenal function, 8 (25 percent) had abnormalities in two axes, 8 (25 percent) in three axes, and 4 (12 percent) in all four axes.Conclusions. Cranial radiotherapy in children and adults with brain tumors frequently causes abnormal hypothalamic-pituitary function. The most frequent changes are hypothyroidism and gonadal dysfunction, although subtle abnormalities in adrenal function may also be present.