Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: A report from the st jude lifetime cohort study

Wassim Chemaitilly, Zhenghong Li, Sujuan Huang, Kirsten K. Ness, Karen L. Clark, Daniel M. Green, Nicole Barnes, Gregory T. Armstrong, Matthew J. Krasin, Deo Kumar Srivastava, Ching Hon Pui, Thomas E. Merchant, Larry E. Kun, Amar Gajjar, Melissa M. Hudson, Leslie L. Robison, Charles A. Sklar

Research output: Contribution to journalArticle

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Abstract

Purpose: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. Patients and Methods: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. Results: The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. Conclusion: Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.

Original languageEnglish (US)
Pages (from-to)492-500
Number of pages9
JournalJournal of Clinical Oncology
Volume33
Issue number5
DOIs
StatePublished - Feb 10 2015

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Hypopituitarism
Follicle Stimulating Hormone
Luteinizing Hormone
Survivors
Cohort Studies
Radiotherapy
Growth Hormone
Thyroid Hormones
Neoplasms
Bone Density
Exercise Tolerance
Physical Fitness
Abdominal Obesity
Muscle Weakness
Health
Dyslipidemias
Energy Metabolism
Walking
Retrospective Studies
Obesity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy : A report from the st jude lifetime cohort study. / Chemaitilly, Wassim; Li, Zhenghong; Huang, Sujuan; Ness, Kirsten K.; Clark, Karen L.; Green, Daniel M.; Barnes, Nicole; Armstrong, Gregory T.; Krasin, Matthew J.; Srivastava, Deo Kumar; Pui, Ching Hon; Merchant, Thomas E.; Kun, Larry E.; Gajjar, Amar; Hudson, Melissa M.; Robison, Leslie L.; Sklar, Charles A.

In: Journal of Clinical Oncology, Vol. 33, No. 5, 10.02.2015, p. 492-500.

Research output: Contribution to journalArticle

Chemaitilly, W, Li, Z, Huang, S, Ness, KK, Clark, KL, Green, DM, Barnes, N, Armstrong, GT, Krasin, MJ, Srivastava, DK, Pui, CH, Merchant, TE, Kun, LE, Gajjar, A, Hudson, MM, Robison, LL & Sklar, CA 2015, 'Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: A report from the st jude lifetime cohort study', Journal of Clinical Oncology, vol. 33, no. 5, pp. 492-500. https://doi.org/10.1200/JCO.2014.56.7933
Chemaitilly, Wassim ; Li, Zhenghong ; Huang, Sujuan ; Ness, Kirsten K. ; Clark, Karen L. ; Green, Daniel M. ; Barnes, Nicole ; Armstrong, Gregory T. ; Krasin, Matthew J. ; Srivastava, Deo Kumar ; Pui, Ching Hon ; Merchant, Thomas E. ; Kun, Larry E. ; Gajjar, Amar ; Hudson, Melissa M. ; Robison, Leslie L. ; Sklar, Charles A. / Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy : A report from the st jude lifetime cohort study. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 5. pp. 492-500.
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title = "Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: A report from the st jude lifetime cohort study",
abstract = "Purpose: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. Patients and Methods: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. Results: The estimated point prevalence was 46.5{\%} for GHD, 10.8{\%} for LH/FSHD, 7.5{\%} for TSHD, and 4{\%} for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7{\%} and 78.5{\%} of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. Conclusion: Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.",
author = "Wassim Chemaitilly and Zhenghong Li and Sujuan Huang and Ness, {Kirsten K.} and Clark, {Karen L.} and Green, {Daniel M.} and Nicole Barnes and Armstrong, {Gregory T.} and Krasin, {Matthew J.} and Srivastava, {Deo Kumar} and Pui, {Ching Hon} and Merchant, {Thomas E.} and Kun, {Larry E.} and Amar Gajjar and Hudson, {Melissa M.} and Robison, {Leslie L.} and Sklar, {Charles A.}",
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T1 - Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy

T2 - A report from the st jude lifetime cohort study

AU - Chemaitilly, Wassim

AU - Li, Zhenghong

AU - Huang, Sujuan

AU - Ness, Kirsten K.

AU - Clark, Karen L.

AU - Green, Daniel M.

AU - Barnes, Nicole

AU - Armstrong, Gregory T.

AU - Krasin, Matthew J.

AU - Srivastava, Deo Kumar

AU - Pui, Ching Hon

AU - Merchant, Thomas E.

AU - Kun, Larry E.

AU - Gajjar, Amar

AU - Hudson, Melissa M.

AU - Robison, Leslie L.

AU - Sklar, Charles A.

PY - 2015/2/10

Y1 - 2015/2/10

N2 - Purpose: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. Patients and Methods: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. Results: The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. Conclusion: Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.

AB - Purpose: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. Patients and Methods: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. Results: The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. Conclusion: Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.

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