Table 1.
Central endocrinopathies.
| Function | Complication | Therapy-related risks | Relationship to time, dose to gland, or organ when applicable | Evaluation/labs | Intervention |
|---|---|---|---|---|---|
| Linear growth | GH deficiency | Surgery | Damage to the pituitary by tumor expansion and/or surgery | Bone age IGF1, IGF-BP3 | GH replacement |
| Radiotherapy to hypothalamus/pituitary | Doses ≥18 Gy (highest risk ≥30 Gy) | GH stimulation test | |||
| Puberty | Central precocious puberty | Radiotherapy to hypothalamus/pituitary | Doses ≥18 Gy, | Bone age | GnRH agonist |
| Girls <5 years old at exposure have a higher risk | Baseline AM LH, FSH, estradiol (girls), or testosterone (boys) | ||||
| Leuprolide stimulation test | |||||
| LH/FSH deficiencya | Surgery | Damage to the pituitary by tumor expansion or growth | Bone age Baseline AM LH, FSH, estradiol (girls), or testosterone (boys) | Induction of puberty/sex hormone replacement therapy | |
| Radiotherapy to hypothalamus/pituitary | Doses ≥30 Gy | ||||
| Partial deficit ≥20 Gy | |||||
| Pituitary, other | ACTH insufficiencya | Surgery | Damage to the pituitary by tumor expansion and/or surgery | 8 a.m. cortisol and ACTH | Hydrocortisone and stress dose teaching |
| Irradiation to hypothalamus or pituitary | Doses ≥30 Gy | Low dose ACTH stimulation test if AM cortisol is abnormal | |||
| Systemic glucocorticoids | Deficiency depends on the doses used and duration of exposure | ||||
| TSH deficiencya | Surgery | Damage to the pituitary by tumor expansion and/or surgery | Free T4 | Levothyroxine | |
| Radiotherapy to hypothalamus/pituitary | Doses ≥30 Gy | ||||
| Central diabetes insipidus | Surgery | Damage to the pituitary by tumor expansion and/or surgery | Plasma electrolytes, serum, and urinary osmolalities. Water deprivation test in equivocal situations | Desmopressin Fluid management | |
GH, growth hormone; IGF-1, insulin-like growth factor-1; IGF-BP3, insulin-like growth factor binding protein 3; GnRH, gonadotropin releasing hormone; ACTH, corticotropin; TSH, thyroid stimulating hormone; AM, morning sample; LH, luteinizing hormone; FSH, follicle-stimulating hormone.
aAlso described in the context of ipilimumab-induced anterior hypophysitis.