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Prolactin insufficiency but normal thyroid hormone levels after cranial radiotherapy in long‐term survivors of childhood leukaemia
Author(s) -
Follin Cecilia,
Link Katarina,
Wiebe Thomas,
Moëll Christian,
Björk Jonas,
Erfurth Eva Marie
Publication year - 2013
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12111
Subject(s) - medicine , endocrinology , prolactin , hormone , thyroid , basal (medicine) , lactation , population , pregnancy , insulin , biology , environmental health , genetics
Summary Background Acute lymphoblastic leukaemia ( ALL ) patients treated with cranial radiotherapy ( CRT ) have an increased risk of GH deficiency ( GHD ). Little is known about insufficiencies of prolactin ( PRL ) and TSH , but also lactation failure has been reported in this population. Objective To study the long‐term outcome of CRT on PRL and thyroid hormone levels in GHD ALL patients and the prevalence of lactation failure. Design Case–control study. Patients We examined 40 GHD and 4 GH insufficient ALL patients, in median 20 years (range: 8–27) after ALL diagnosis and 44 matched population controls. Measurements PRL secretion (area under the curve; AUC ) after GHRH ‐arginine test in all patients and matched controls, and PRL and TSH AUC after a TRH ‐test in 13 patients and 13 controls. And basal PRL and thyroid hormone levels after 5 years with GH therapy and 8 years without GH therapy. Results Compared with controls, ALL patients had significantly lower basal and AUC PRL after GHRH ‐Arginine ( P = 0·03, P = 0·02), and AUC PRL after TRH ( P = 0·001). After 5 and 8 years, PRL levels decreased further ( P = 0·01, P = 0·03), but thyroid hormones remained normal at baseline and at follow‐up. PRL insufficiency was significantly associated with increased levels of BMI and insulin. Six out of seven pregnant ALL women reported lactation failure. Conclusions Long‐term ALL survivors treated with CRT have GHD and PRL insufficiency, and a high prevalence of lactation failure, but thyroid hormones remained normal. PRL insufficiency was associated with cardiovascular risk.