title: Pituitary dysfunction in adult patients after cranial radiotherapy: systematic review and meta-analysis.
abstract: BACKGROUND
  Cranial radiotherapy is an important cause of hypopituitarism. The prevalence of hypopituitarism varies considerably between studies.
  
  
  OBJECTIVE
  We conducted a systematic review and meta-analysis of reported prevalences of hypopituitarism in adults radiated for nonpituitary tumors.
  
  
  METHODS
  We searched PubMed, EMBASE, Web of Science, and the Cochrane Library to identify potentially relevant studies.
  
  
  METHODS
  Studies were eligible for inclusion with the following criteria: 1) cranial radiotherapy for nonpituitary tumors and/or total body irradiation for hematological malignancies; 2) adult population (>18 yr old); and 3) report on endocrine evaluation.
  
  
  METHODS
  Data review was done by two independent reviewers. Besides extraction of baseline and treatment characteristics, also endocrine tests, definitions, and cutoff values used to define pituitary insufficiency were extracted.
  
  
  RESULTS
  Eighteen studies with a total of 813 patients were included. These included 608 patients treated for nasopharyngeal cancer (75%) and 205 for intracerebral tumors. The total radiation dose ranged from 14 to 83 and 40 to 97 Gy for nasopharyngeal and intracerebral tumors, respectively. The point prevalence of any degree of hypopituitarism was 0.66 [95% confidence interval (CI), 0.55-0.76]. The prevalence of GH deficiency was 0.45 (95% CI, 0.33-0.57); of LH and FSH, 0.3 (95% CI, 0.23-0.37); of TSH, 0.25 (95% CI, 0.16-0.37); and of ACTH, 0.22 (95% CI, 0.15-0.3), respectively. The prevalence of hyperprolactinemia was 0.34 (95% CI, 0.15-0.6). There were no differences between the effects of radiotherapy for nasopharyngeal vs. for intracerebral tumors.
  
  
  CONCLUSIONS
  Hypopituitarism is prevalent in adult patients after cranial radiotherapy for nonpituitary tumors. Therefore, all patients treated by cranial radiotherapy should have structured periodical assessment of pituitary functions.
authors: Department of Endocrinology and Metabolism, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. n.m.appelman-dijkstra@lumc.nl
authors: Natasha M
authors: NM
authors: Appelman-Dijkstra
authors: Nieke E
authors: NE
authors: Kokshoorn
authors: Olaf M
authors: OM
authors: Dekkers
authors: Karen J
authors: KJ
authors: Neelis
authors: Nienke R
authors: NR
authors: Biermasz
authors: Johannes A
authors: JA
authors: Romijn
authors: Johannes W A
authors: JW
authors: Smit
authors: Alberto M
authors: AM
authors: Pereira
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