title: Prolactin insufficiency but normal thyroid hormone levels after cranial radiotherapy in long-term survivors of childhood leukaemia.
abstract: BACKGROUND
  Acute lymphoblastic leukaemia (ALL) patients treated with cranial radiotherapy (CRT) have an increased risk of GH deficiency (GHD). Little is known about insufficiencies of prolactin (PRL) and TSH, but also lactation failure has been reported in this population.
  
  
  OBJECTIVE
  To study the long-term outcome of CRT on PRL and thyroid hormone levels in GHD ALL patients and the prevalence of lactation failure.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  We examined 40 GHD and 4 GH insufficient ALL patients, in median 20 years (range: 8-27) after ALL diagnosis and 44 matched population controls.
  
  
  METHODS
  PRL secretion (area under the curve; AUC) after GHRH-arginine test in all patients and matched controls, and PRL and TSH AUC after a TRH-test in 13 patients and 13 controls. And basal PRL and thyroid hormone levels after 5 years with GH therapy and 8 years without GH therapy.
  
  
  RESULTS
  Compared with controls, ALL patients had significantly lower basal and AUC PRL after GHRH-Arginine (P = 0·03, P = 0·02), and AUC PRL after TRH (P = 0·001). After 5 and 8 years, PRL levels decreased further (P = 0·01, P = 0·03), but thyroid hormones remained normal at baseline and at follow-up. PRL insufficiency was significantly associated with increased levels of BMI and insulin. Six out of seven pregnant ALL women reported lactation failure.
  
  
  CONCLUSIONS
  Long-term ALL survivors treated with CRT have GHD and PRL insufficiency, and a high prevalence of lactation failure, but thyroid hormones remained normal. PRL insufficiency was associated with cardiovascular risk.
authors.affiliation: Department of Endocrinology, Skåne University Hospital, Lund, Sweden. cecilia.follin@med.lu.se
authors.forename: Cecilia
authors.initials: C
authors.lastname: Follin
authors.forename: Katarina
authors.initials: K
authors.lastname: Link
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiebe
authors.forename: Christian
authors.initials: C
authors.lastname: Moëll
authors.forename: Jonas
authors.initials: J
authors.lastname: Björk
authors.forename: Eva Marie
authors.initials: EM
authors.lastname: Erfurth
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000378:metabolism / Q000532:radiotherapy*; D011388:Prolactin / Q000097:blood / Q000172:deficiency* / Q000378:metabolism; D017741:Survivors; D013963:Thyroid Hormones / Q000097:blood / Q000378:metabolism*; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013963:Thyroid Hormones; D011388:Prolactin; D013972:Thyrotropin; D013006:Growth Hormone