Endocrine Sequelae of Antineoplastic Therapy in Childhood Head and Neck Malignancies*

Abstract

Twelve children, 6-9 yr of age, with primary tumors of the head and neck region, underwent endocrine testing 4 months to 9 yr after completion of antineoplastic therapy. They had received radiation therapy to the primary tumor site, followed by a 2-yr course of chemotherapy. All received incidental hypothalamic-pituitary irradiation (estimated dose, 2520- 7200 rads over 41-109 days) and five patients received thyroid irradiatio(1300-5000 rads over 5-56 days). All patients were free of disease at the time of study Seven patients were below the fifth percentile in height, and all 12 were below the tenth. Eleven of the 12 patients showed subnormal GH responses to insulin-induced hypoglycemia (≤7 ng⁄ml). Five of 6 patients also had deficient GH responses to Ldop (≤6 ng⁄ml). One patient had a subnormal cortisol response to insulin-induced hypoglycemia (peak,<20 jug⁄dl). Three patients had primary thyroidal dysfunction, and 1 had evidence of hypothalamic hypothyroidism. One patient had elevated basal PRL levels. Seven patients had elevated basal LH and/or FSH levels. One patient was azoospermic, and 2 postpubertal girls had menstrual abnormalities. In 6 of 8 pubertaland postpubertal subjects, the FSH response to LRH was greater than the LH response. The data show a high prevalence of hypothalamic-pituitary-target organ dysfunction in children treated with both chemotherapy and radiation therapy to the head and neck regionCareful surveillance of endocrine status is warranted in such children responsive to antineoplastic therapy.