Radiotherapy-induced hypopituitarism: a review

Abstract

Hypopituitarism is a disorder caused by impaired hormonal secretions from the hypothalamic–pituitary axis. Radiotherapy is the most common cause of iatrogenic hypopituitarism. The hypothalamic–pituitary axis inadvertently gets irradiated in patients receiving prophylactic cranial radiotherapy for leukemia, total body irradiation and radiotherapy for intracranial, base skull, sinonasal and nasopharyngeal tumors. Radiation-induced hypopituitarism (RIH) is insidious, progressive and largely nonreversible. Mostly, RIH involves one hypothalamic–pituitary axis; however, multiple hormonal axes deficiency starts developing at higher doses. Although the clinical effects of the hypopituitarism are more profound in children and young adults, its implications in older adults are being increasingly recognized. The risk continues to persist or increase up to 10 years following radiation exposure. The clinical management of hypopituitarism is challenging both for the patients and healthcare providers. Here we have reviewed the scale of the problem, the risk factors and the management of RIH.

Keywords::

• cancer survivors
• hypopituitarism
• late effect
• nasopharyngeal cancer
• neuroendocrinopathy
• pituitary
• pituitary dysfunction
• radiotherapy
• skull base tumors
• toxicity

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.