The hypothalamic–pituitary–adrenal axis in childhood cancer survivors
Endocrine abnormalities are common among childhood cancer survivors. Abnormalities of the hypothalamic–pituitary–adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic–pituitary regio...
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Veröffentlicht in: | Endocrine-related cancer 2018-10, Vol.25 (10), p.R479-R496 |
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description | Endocrine abnormalities are common among childhood cancer survivors. Abnormalities of the hypothalamic–pituitary–adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic–pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment. |
doi_str_mv | 10.1530/ERC-18-0217 |
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Abnormalities of the hypothalamic–pituitary–adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic–pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment.</description><identifier>ISSN: 1351-0088</identifier><identifier>EISSN: 1479-6821</identifier><identifier>DOI: 10.1530/ERC-18-0217</identifier><identifier>PMID: 29895525</identifier><language>eng</language><publisher>England: Bioscientifica Ltd</publisher><subject>Adrenal glands ; Adrenocorticotropic hormone ; Cancer ; Children ; Glucocorticoids ; Hypothalamic-pituitary-adrenal axis ; Hypothalamus ; Immunotherapy ; Insulin ; Medical personnel ; Patients ; Pituitary ; Pituitary hormones ; Radiation therapy ; Review ; Steroid hormones ; Surgery ; Tumors</subject><ispartof>Endocrine-related cancer, 2018-10, Vol.25 (10), p.R479-R496</ispartof><rights>2018 Society for Endocrinology</rights><rights>2018 Society for Endocrinology.</rights><rights>Copyright Society for Endocrinology & BioScientifica Ltd. 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Abnormalities of the hypothalamic–pituitary–adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic–pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment.</description><subject>Adrenal glands</subject><subject>Adrenocorticotropic hormone</subject><subject>Cancer</subject><subject>Children</subject><subject>Glucocorticoids</subject><subject>Hypothalamic-pituitary-adrenal axis</subject><subject>Hypothalamus</subject><subject>Immunotherapy</subject><subject>Insulin</subject><subject>Medical personnel</subject><subject>Patients</subject><subject>Pituitary</subject><subject>Pituitary hormones</subject><subject>Radiation therapy</subject><subject>Review</subject><subject>Steroid hormones</subject><subject>Surgery</subject><subject>Tumors</subject><issn>1351-0088</issn><issn>1479-6821</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp90M9KxDAQBvAgiuu_k3cpeBGkOkmbNjnKsurCgiB6LtM0pZG2WZN2cW--g2_ok5hl1YMHD8PM4ccH8xFySuGK8gSuZ4_TmIoYGM13yAFNcxlngtHdcCecxgBCTMih9y8AkAnO98mESSE5Z_yAzJ8aHTXrpR0abLEz6vP9Y2mG0Qzo1uHGyuke2wjfjI9MH6nGtFVjbRUp7JV2kR_dyqys88dkr8bW65PvfUSeb2dP0_t48XA3n94s4jKR2RAnoDDXIKRCzKqsZJJhKilXdVWlWQ05EyCgRK2wwkRDltaYCEChRK5pxpMjcrHNXTr7Omo_FJ3xSrct9tqOvmDAU8lZnshAz__QFzu68E5QlLIwEvKgLrdKOeu903WxdKYL7xcUik3DRWi4oKLYNBz02XfmWHa6-rU_lQZAt6A01iuj-8HURuG_oV8QGIhP</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Wei, Christina</creator><creator>Crowne, Elizabeth C</creator><general>Bioscientifica Ltd</general><general>Society for Endocrinology & BioScientifica Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201810</creationdate><title>The hypothalamic–pituitary–adrenal axis in childhood cancer survivors</title><author>Wei, Christina ; Crowne, Elizabeth C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b396t-30ca7e089caa6d6b292a4915cfdd46f0728080baecada3e064fa380a8c87e1653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adrenal glands</topic><topic>Adrenocorticotropic hormone</topic><topic>Cancer</topic><topic>Children</topic><topic>Glucocorticoids</topic><topic>Hypothalamic-pituitary-adrenal axis</topic><topic>Hypothalamus</topic><topic>Immunotherapy</topic><topic>Insulin</topic><topic>Medical personnel</topic><topic>Patients</topic><topic>Pituitary</topic><topic>Pituitary hormones</topic><topic>Radiation therapy</topic><topic>Review</topic><topic>Steroid hormones</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wei, Christina</creatorcontrib><creatorcontrib>Crowne, Elizabeth C</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Endocrine-related cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wei, Christina</au><au>Crowne, Elizabeth C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The hypothalamic–pituitary–adrenal axis in childhood cancer survivors</atitle><jtitle>Endocrine-related cancer</jtitle><addtitle>Endocr Relat Cancer</addtitle><date>2018-10</date><risdate>2018</risdate><volume>25</volume><issue>10</issue><spage>R479</spage><epage>R496</epage><pages>R479-R496</pages><issn>1351-0088</issn><eissn>1479-6821</eissn><abstract>Endocrine abnormalities are common among childhood cancer survivors. Abnormalities of the hypothalamic–pituitary–adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic–pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment.</abstract><cop>England</cop><pub>Bioscientifica Ltd</pub><pmid>29895525</pmid><doi>10.1530/ERC-18-0217</doi><oa>free_for_read</oa></addata></record> |
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subjects | Adrenal glands Adrenocorticotropic hormone Cancer Children Glucocorticoids Hypothalamic-pituitary-adrenal axis Hypothalamus Immunotherapy Insulin Medical personnel Patients Pituitary Pituitary hormones Radiation therapy Review Steroid hormones Surgery Tumors |
title | The hypothalamic–pituitary–adrenal axis in childhood cancer survivors |
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