Endocrine disturbances and quality of life in adult patients after multimodal treatment for brain tumors or leukemia
S. Siegel1,2, E. Rosenkranz2, A. Thissen2, M. Piroth1, R. Mertens1, C. Streetz-van-der-Werf1, G. Brabant3 & I. Kreitschmann-Andermahr1,2
Objective: Brain tumour treatment with radio- and chemotherapy may lead to endocrine and other medical sequelae. Still, many countries lack tailored surveillance programs for such patients so that potential health problems may remain unrecognized. The present study was performed to investigate endocrine and psychosocial impairment in a single centre university setting in Germany in patients treated with cranial radiotherapy as a part of brain tumour or leukaemia treatment.
Patients and methods: 38 (18 m, 20 f) brain tumour patients were investigated at least three year after completion of radiotherapy. 26 had been operated upon and 19 had received additional chemotherapy. 16 patients were childhood cancer survivors, 22 were diagnosed and treated as adults. In all patients basal 0800 h hormone levels (cortisol, ACTH, GH, IGF1, fT3, fT4, TSH, LH, FSH, testosterone or estrogen) were assessed. In case of abnormal basal hormone readings or clinical suspicion of hormonal abnormalities, functional endocrine assessment was additionally performed. An extensive self-rating battery pertaining to quality of life, sleep disturbances and depression was also completed by all patients.
Results: In one patient previously undetected deficiency of three pituitary hormone axes was noted, a total of eight patients had abnormally low IGF1 levels, three secondary and three primary hypogonadism. Primary hypothyroidism, probably associated with brain tumour treatment (radiotherapy of the neuroaxis in medulloblastoma patients) was noted in two patients. Patients presented with a wide range of psychosocial impairment with women and overweight patients being more impaired than others. Higher testosterone levels were related to better psychological quality of life as indicated by the psychological sum score of the SF-36 (r=0.494, P<0.05).
Conclusion: The results of the present study underscore the need for organized assessment and treatment of medical and psychosocial late sequelae even years after multimodal brain tumour treatment.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.