Session: SUN 410-423-Hypothalamic-Pituitary-Adrenal Axis (posters)
Poster Board SUN 423
Background: Advances in treatment of childhood brain tumors have increased survival time and quality of life for survivors; however, endocrine late effects often develop from tumor therapy. ACTH deficiency (ACTHD) is an uncommon hormone deficiency and lacks clear guidelines for surveillance despite life-threatening risks if undetected. We evaluated screening for ACTHD and other endocrinopathies within our multi-disciplinary neuro-oncology clinic.
Objective: To identify prevalence and time to onset of ACTHD to allow refinement of screening strategies among brain tumor survivors.
Methods: Retrospective chart review of 471 patients evaluated for brain tumor from 2002 to 2012. ACTHD was defined as peak serum cortisol <18 µg/dL twenty minutes after administration of 1µg/m2 intravenous ACTH. Peak cortisol >20 µg/dL was defined as normal while 18 -20 µg/dL was indeterminate. For random cortisol levels, ACTHD was defined as cortisol <13 µg/dL drawn at 0700-0900, while ≥13 µg/dL at any hour of the day was considered normal. Timing of tumor therapies, location of brain tumor, and presence of other endocrinopathies were recorded.
Results: Of the 471 reviewed, 419 were included for analysis (6 excluded for no brain tumor diagnosis, 46 excluded for incomplete records). An endocrine evaluation occurred in 254 (60.6%) with an endocrine abnormality in 114 (45%) of those tested. Prevalence of endocrinopathies in the 254 included central hypothyroidism, 52.6%; GH deficiency, 38.6%; precocious puberty, 30.7%; GnRH deficiency, 27.2%; primary hypothyroidism, 21.1%; diabetes insipidus, 19.3%; and hyperprolactinemia, 6.1%. Only 151/419 patients (36.0%) completed ACTHD testing at our center: 59.4% with suprasellar, 31.7% with posterior fossa, 29.1% with supratentorial, and 10.0% with spinal cord tumors. Abnormal ACTH occurred in 14.6% of 151 tested (ACTHD, 16; indeterminate, 6). Median time from tumor diagnosis to diagnosis of ACTHD was 2.1 years (IQR 0.3-3.8, maximum 11.4). Patients with tumor recurrence with repeated irradiation or surgery had increased risk for later diagnosis of ACTHD and temporally near the timing of these therapies.
Conclusions: ACTHD most often occurred within the first 5 years after tumor diagnosis among brain tumor survivors. Tumor recurrence with repeat resection or irradiation increased the risk for later diagnosis. Other endocrinopathies most often occurred within the first 6 years after tumor diagnosis or following repeated therapies or recurrence. Even within our multidisciplinary clinic, screening rates for all endocrinopathies were low, including within the suprasellar group. We recommend implementing screening protocols to improve detection rates of endocrinopathies, targeted to the first 5 years after tumor therapy is completed.
Nothing to Disclose: VEH, MCG, LH, SM, JK, KB, MF, SRR, SL
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