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Moderate dose cranial radiotherapy causes central adrenal insufficiency in long-term survivors of childhood leukaemia.

Follin, Cecilia LU ; Wiebe, Thomas LU ; Moëll, Christian LU and Erfurth, Eva Marie LU (2014) In Pituitary 17(1). p.7-12
Abstract
Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. The survival rate in the Scandinavian countries is now around 85 %. ALL patients treated with cranial radiotherapy (CRT) are at risk for growth hormone deficiency (GHD), but little is known about other pituitary insufficiencies, e.g. ACTH. Adult ALL patients (median age at study 25 years), treated with 24 Gy (18-30) of CRT during childhood were investigated. We performed an insulin tolerance test (ITT) to evaluate cortisol secretion. We measured basal serum ACTH and cortisol levels before and after 5 years of GH therapy. 14 out of 37 (38 %) ALL patients had a subnormal cortisol response to an ITT (257-478 nmol/L) while there was no significant difference in basal... (More)
Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. The survival rate in the Scandinavian countries is now around 85 %. ALL patients treated with cranial radiotherapy (CRT) are at risk for growth hormone deficiency (GHD), but little is known about other pituitary insufficiencies, e.g. ACTH. Adult ALL patients (median age at study 25 years), treated with 24 Gy (18-30) of CRT during childhood were investigated. We performed an insulin tolerance test (ITT) to evaluate cortisol secretion. We measured basal serum ACTH and cortisol levels before and after 5 years of GH therapy. 14 out of 37 (38 %) ALL patients had a subnormal cortisol response to an ITT (257-478 nmol/L) while there was no significant difference in basal cortisol levels between 44 patients and controls (P > 0.3). Female, but not male ALL patients had significantly lower ACTH levels compared to controls (P = 0.03). After 5 years of GH therapy only male ALL patients had significantly lowered basal plasma cortisol (P = 0.02). ALL survivors, treated with a moderate dose CRT, have a central adrenal insufficiency 20 years after diagnosis. An increased awareness of the risk for an adrenal insufficiency is of importance and life-long surveillance of the entire hypothalamic-pituitary axis is recommended in these patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Pituitary
volume
17
issue
1
pages
7 - 12
publisher
Springer
external identifiers
  • wos:000329997000002
  • pmid:23283630
  • scopus:84895073563
ISSN
1573-7403
DOI
10.1007/s11102-012-0459-8
language
English
LU publication?
yes
id
36a06885-ad98-4307-b4ce-644067be6dab (old id 3439044)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23283630?dopt=Abstract
date added to LUP
2013-02-04 10:08:41
date last changed
2017-01-29 03:17:24
@article{36a06885-ad98-4307-b4ce-644067be6dab,
  abstract     = {Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. The survival rate in the Scandinavian countries is now around 85 %. ALL patients treated with cranial radiotherapy (CRT) are at risk for growth hormone deficiency (GHD), but little is known about other pituitary insufficiencies, e.g. ACTH. Adult ALL patients (median age at study 25 years), treated with 24 Gy (18-30) of CRT during childhood were investigated. We performed an insulin tolerance test (ITT) to evaluate cortisol secretion. We measured basal serum ACTH and cortisol levels before and after 5 years of GH therapy. 14 out of 37 (38 %) ALL patients had a subnormal cortisol response to an ITT (257-478 nmol/L) while there was no significant difference in basal cortisol levels between 44 patients and controls (P > 0.3). Female, but not male ALL patients had significantly lower ACTH levels compared to controls (P = 0.03). After 5 years of GH therapy only male ALL patients had significantly lowered basal plasma cortisol (P = 0.02). ALL survivors, treated with a moderate dose CRT, have a central adrenal insufficiency 20 years after diagnosis. An increased awareness of the risk for an adrenal insufficiency is of importance and life-long surveillance of the entire hypothalamic-pituitary axis is recommended in these patients.},
  author       = {Follin, Cecilia and Wiebe, Thomas and Moëll, Christian and Erfurth, Eva Marie},
  issn         = {1573-7403},
  language     = {eng},
  number       = {1},
  pages        = {7--12},
  publisher    = {Springer},
  series       = {Pituitary},
  title        = {Moderate dose cranial radiotherapy causes central adrenal insufficiency in long-term survivors of childhood leukaemia.},
  url          = {http://dx.doi.org/10.1007/s11102-012-0459-8},
  volume       = {17},
  year         = {2014},
}