ACTH deficiency in childhood cancer survivors.
BACKGROUND
Adrenocorticotropin deficiency (ACTHD) can be clinically subtle, but life-threatening if not recognized. We assessed the prevalence of ACTHD in survivors of childhood cancer according to tumor diagnosis/therapy.


METHODS
Chart review of endocrine/oncology history was performed in 310 childhood cancer survivors. Patients were referred to endocrine clinic because of slow growth, fatigue, or abnormal pubertal timing. Evaluation of growth hormone (GH), thyrotropin (TSH), ACTH, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) was performed. Low response to metyrapone and/or low dose ACTH test defined ACTHD.


RESULTS
ACTHD was identified in 56 (18%), [44 of 182 (24%) central nervous system (CNS) tumors, 3 of 18 (17%) non-CNS cranial tumors, 9 of 97 (9%) hematologic malignancies]. Of the 56 with ACTHD, 53 (95%) had received cranial irradiation (mean 45.5 Gy, range 14-70 Gy); three had not: one each with craniopharyngioma, hypothalamic astrocytoma, and brain stem glioma. All but one also had GH deficiency and/or central hypothyroidism.


CONCLUSIONS
Childhood cancer survivors with greatest risk for ACTHD had craniopharyngioma, other suprasellar tumor, or medulloblastoma or > or =24 Gy cranial irradiation. We recommend annual testing for ACTHD for 10-15 years and continued lifelong surveillance after CNS tumor or cranial irradiation, in patients with other hypothalamic-pituitary deficiencies or symptoms of ACTHD.
Rose
Susan R
SR
Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. susan.rose@cchmc.org
Danish
Robert K
RK
Kearney
Nicole S
NS
Schreiber
Randi E
RE
Lustig
Robert H
RH
Burghen
George A
GA
Hudson
Melissa M
MM
D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D002648:Child; D016371:Cranial Irradiation / Q000009:adverse effects; D005221:Fatigue; D006130:Growth Disorders; D006728:Hormones / Q000097:blood; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000532:radiotherapy; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011628:Puberty, Delayed; D017741:Survivors
D006728:Hormones; D000324:Adrenocorticotropic Hormone