Endocrine Abstracts

Cranial radiotherapy is widely used in combination with chemotherapy to treat patients with primary brain tumours. Increased survival has lead to the recognition of long term sequelae, including endocrine dysfunction due to radiation-induced hypothalamic–pituitary damage. Here we assessed health-related quality of life and endocrine function in 31 adult long term survivors (median age 45, range 29–65 years; 21M, 10F) of primary brain tumours outside the hypothalamic–pituitary region (WHO grade II (n=9), III (n=15) and IV (n=3)) who had received cranial irradiation prior to assessment (median 51, range 10–168 months). Health-related quality of life was measured by validated self-assessment questionnaires including the revised Symptom Check List 90 (SCL-90-R), Giessen Complaint List (GBB-24), Multidimensional Affect Rating Scale (MDBF), and the Hospital Anxiety and Depression scale (HADS). Endocrine function was assessed by serum cortisol (basal and ACTH-stimulated), DHEAS, TFTs, IGF-I and prolactin. Endocrine dysfunction (ED), defined by at least one abnormal pituitary axis, was discovered in 15 patients (median 2, range 1–2 deficient axes), whereas the other 16 patients had a normal hormonal profile (No ED). Age, sex distribution and time post radiation did not differ in both groups. However, the biological effective dose (BED) of administered radiation was significantly higher in ED versus No ED patients, both with regard to the pituitary (Median(IQR): 115(58,140) vs 70(31,101) Gy) and the hypothalamus region (119(90,140) vs 92(44,122) Gy) (all P<0.05). Assessment of the SCL-90-R questionnaire showed significantly higher scores for the ED group (all P<0.05) with regard to overall global severity index and the subscales somatisation and psychotic tendencies, the latter scale has been reported to reflect cognitive impairment. MDBF results revealed significantly higher restlessness scores in ED patients (P<0.05). Our data provide evidence that cranial radiation therapy in patients with brain tumours outside the hypothalamic–pituitary area leads to a high incidence of hypothalamic–pituitary dysfunction associated with significantly impaired quality of life.