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Prevalence and risk factors for radiotherapy-induced hypopituitarism in survivors of primary, non-pituitary brain tumours treated with intensity-modulated radiotherapy
Darran Mc Donald 1,2 , Liam O’Connell 3 , Maria Tomkins 1,2 , Tara Mc Donnell 1,2 , Niamh Mc Dermott 1 , Jack Lee 1 , Clare Carthy 1 , Mary Moore 1 , Amar Agha 1,2 , Donncha O’Brien 1 , Kieron Sweeney 1 , Stephen Mc Nally 1 , Mohsen Javadpour 1 , Clare Faul 2,3 , David Fitzpatrick 3 , Michael W. O’Reilly 1,2 & Mark Sherlock 1,2
1Beaumont Hospital, Dublin, Ireland; 2Royal College of Surgeons in Ireland, Dublin, Ireland; 3St Luke’s Radiation Oncology Network, Dublin, Ireland
Cranial irradiation is a well described cause of hypopituitarism. However, there is limited evidence estimating the risk of hypopituitarism in non-pituitary brain tumour survivors treated with newer radiotherapy techniques including intensity-modulated radiotherapy (IMRT). We assessed the prevalence and risk factors associated with radiotherapy-induced hypopituitarism in adult survivors of brain tumours that were distant from the hypothalamic-pituitary-axis and treated with IMRT. Pituitary function was assessed in 140 brain tumour survivors between 2012-2022. Prospectively recruited survivors (n = 54) underwent a glucagon stimulation and baseline pituitary testing. Retrospective patients (n = 86) underwent annual synacthen testing and pituitary profile, with growth hormone (GH) assessments in selected survivors. Median age at radiotherapy was 39.7 years (IQR 30.5-49.8) and follow-up interval following radiotherapy was 60.5 months (IQR 36.0-83.0). Prevalence of hypopituitarism was 55% (n = 51/93). GH deficiency occurred in 54% (n = 50/93), gonadotropin deficiency in 11% (n = 15/138), adrenocorticotrophic hormone (ACTH) in 12% (n = 17/138), thyroid-stimulating hormone (TSH) deficiency in 9% (n = 12/137). A composite outcome of gonadotropin, ACTH or TSH deficiency occurred in 16% (n = 22/134). Multivariate logistic regression analysis revealed higher pituitary doses were significantly associated with developing deficits across all hormone axes. Longer follow-up interval was significantly associated with gonadotropin and TSH deficiency. The composite prevalence of gonadotropin, ACTH or TSH deficiency was significantly lower in this study compared to a previous study in our institution using older 2 and 3-dimensional radiotherapy (16 vs. 34%, P < 0.01). The prevalence of the most clinically significant pituitary hormone deficiencies (ACTH, TSH and gonadotropin) is relatively low, potentially occurring less frequently with modern radiotherapy techniques.
Volume 115
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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