Anterior Hypopituitarism in Adult Survivors of Childhood Cancers Treated With Cranial Radiotherapy: A Report From the St Jude Lifetime Cohort Study
Anterior Hypopituitarism in Adult Survivors of Childhood Cancers Treated With Cranial Radiotherapy: A Report From the St Jude Lifetime Cohort Study
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DOI：
10.1200/jco.2014.56.7933
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发表时间：
2015-02-10
影响因子：
45.3
通讯作者：
Sklar, Charles A.
中科院分区：
文献类型：
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作者：
Chemaitilly, Wassim;Li, Zhenghong;Sklar, Charles A.
目的评估生长激素缺乏症（GHD）、促黄体生成激素/促卵泡激素缺乏症（LH/FSHD）、促甲状腺激素缺乏症（TSHD）、儿童癌症幸存者（CCS）接受颅骨放疗（CRT）后出现促肾上腺皮质激素缺乏症（ACTHD）患者和方法回顾性研究在一个既定的队列的CCS与748名参与者接受CRT治疗（394例男性;平均年龄为34.2岁[范围：19.4 - 59.6岁]，平均观察年龄为27.3岁[范围：10.8 - 47.7岁]）。多变量logistic回归分析用于研究人口统计学和治疗相关的危险因素与垂体缺陷之间的关联，以及未经治疗的缺陷与心血管健康，骨密度（BMD）和身体fitness.Results的估计点患病率为46.5% GHD，10.8% LH/FSHD，7.5% TSHD，4% ACTHD，累积发病率随随访增加而增加。GHD和LH/FSHD分别在99.7%和78.5%的受影响个体中未接受治疗。男性和肥胖与LH/FSHD显著相关;白色人种与LH/FSHD和TSHD显著相关。与CRT剂量小于22戈伊相比，22 ~ 29.9戈伊剂量与GHD显著相关; 22戈伊剂量与LH/FSHD相关; 30戈伊剂量与TSHD和ACTHD相关。未经治疗的GHD与肌肉质量和运动耐量下降显著相关;未经治疗的LH/FSHD与高血压、血脂异常、低BMD和缓慢行走相关;这两种缺陷独立地与腹部肥胖、低能量消耗和肌无力相关。注意到GHD和LH/FSHD随时间的持续发展，这些疾病的不治疗与不良健康结局之间可能存在相关性。
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.