J Neurol Surg B 2020; 81(01): 075-081
DOI: 10.1055/s-0039-1679893
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening

1  Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
,
Katayoon Sabetsarvestani
2  Michigan State University College of Human Medicine, East Lansing, Michigan, United States
,
Stephen E. Sullivan
3  Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Ariel Barkan
4  Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
,
Michelle Mierzwa
5  Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States
,
Erin L. McKean
1  Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
3  Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
› Author Affiliations
Funding 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.
Further Information

Publication History

20 August 2018

30 December 2018

Publication Date:
21 February 2019 (online)

Abstract

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.

Author Contributions

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.