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ACTH deficiency in childhood cancer survivors
Author(s) -
Rose Susan R.,
Danish Robert K.,
Kearney Nicole S.,
Schreiber Randi E.,
Lustig Robert H.,
Burghen George A.,
Hudson Melissa M.
Publication year - 2005
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20327
Subject(s) - medicine , craniopharyngioma , growth hormone deficiency , endocrine system , medulloblastoma , cancer , pituitary tumors , brain tumor , hormone , oncology , endocrinology , pathology , growth hormone
Background Adrenocorticotropin deficiency (ACTHD) can be clinically subtle, but life‐threatening if not recognized. We assessed the prevalence of ACTHD in survivors of childhood cancer according to tumor diagnosis/therapy. Procedure Chart review of endocrine/oncology history was performed in 310 childhood cancer survivors. Patients were referred to endocrine clinic because of slow growth, fatigue, or abnormal pubertal timing. Evaluation of growth hormone (GH), thyrotropin (TSH), ACTH, luteinizing hormone (LH), and follicle‐stimulating hormone (FSH) was performed. Low response to metyrapone and/or low dose ACTH test defined ACTHD. Results ACTHD was identified in 56 (18%), [44 of 182 (24%) central nervous system (CNS) tumors, 3 of 18 (17%) non‐CNS cranial tumors, 9 of 97 (9%) hematologic malignancies]. Of the 56 with ACTHD, 53 (95%) had received cranial irradiation (mean 45.5 Gy, range 14–70 Gy); three had not: one each with craniopharyngioma, hypothalamic astrocytoma, and brain stem glioma. All but one also had GH deficiency and/or central hypothyroidism. Conclusions Childhood cancer survivors with greatest risk for ACTHD had craniopharyngioma, other suprasellar tumor, or medulloblastoma or ≥24 Gy cranial irradiation. We recommend annual testing for ACTHD for 10–15 years and continued lifelong surveillance after CNS tumor or cranial irradiation, in patients with other hypothalamic–pituitary deficiencies or symptoms of ACTHD. © 2005 Wiley‐Liss, Inc.