Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and ScreeningFunding There was no funding for this research. The authors have no relevant conflicts of interest to disclose. This review was conducted under IRB approval HUM00036763. All patients were appropriately consented for enrollment and participation.
This article demonstrates a significant incidence (37%) of radiation-induced hypopituitarism after treatment of anterior cranial base malignancies. This incidence is likely underestimated by many clinicians, and we describe a yearly screening protocol that could be utilized for surveillance.
20 August 2018
30 December 2018
21 February 2019 (online)
Background Management of anterior cranial base malignancies requires multidisciplinary care. Radiation therapy remains a mainstay of definitive or adjuvant treatment. Apart from primary hypothyroidism, the effects of radiation on the hypothalamic–pituitary axis after high-dose treatment of head and neck malignancies remain poorly described. We describe a comprehensive screening protocol for surveillance and characterize the incidence of pituitary dysfunction after radiation for anterior cranial base malignancies.
Methods A review of patients prospectively enrolled in a skull base registry at an academic center was performed. Included patients had a history of anterior skull base malignancy and external beam radiation to the primary site, with comprehensive post-treatment pituitary serologies and at least 1 year of post-radiation follow-up. Routine hormonal screening was initiated during the study period for all patients with anterior skull base irradiation.
Results Eighty-one patients met inclusion. Fifty-eight patients (71%) demonstrated some laboratory abnormality. Thirty patients (37%) demonstrated evidence of hypopituitarism. Twenty-four (29%) demonstrated central hypogonadism, and 16% of patients showed central hypothyroidism. Ten patients (12%) displayed central adrenal insufficiency with six patients demonstrating panhypopituitarism. Primary tumor location and maximum dose of radiation to the gland appeared to correlate with incidence of hypopituitarism.
Conclusion Radiation for malignancies of the anterior skull base resulted in a 37% incidence of hypopituitarism in our study. Given the potential morbidity of hypopituitarism, we recommend annual post-treatment screening in these patients. We describe a comprehensive set of serologies that can be utilized, and recommend updating clinical guidelines to reflect the necessity of this screening.
Keywordssinonasal malignancies - radiation side effects - radiation-induced hypopituitarism - hypopituitarism screening
Kyle VanKoevering: Data acquisition, analysis, statistics, drafting, reviewing, and editing. Katayoon Sabetsarvestani: Data acquisition, reviewing, and editing. Stephen E. Sullivan: Conceptualization, reviewing, and editing. Ariel Barkan: Data analysis, critical review, and editing. Michelle Mierzwa: Data acquisition, analysis, critical review, and editing. Erin L. McKean: Conceptualization, data analysis, critical review, and editing.
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