Hypopituitarism following radiotherapy revisited

Endocrine Development

Volumn 15, Issue , 2009, Pages 1-24

  Darzy, Ken H ^a   Shalet, Stephen M ^a  

^a CHRISTIE HOSPITAL   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CORTICOTROPIN; GONADOTROPIN; PROLACTIN; THYROTROPIN; HUMAN GROWTH HORMONE;

BODY IMAGE; BRAIN TUMOR; CORTICOTROPIN DEFICIENCY; FOLLOW UP; GOLD STANDARD; GONADOTROPIN RELEASE; GROWTH; GROWTH HORMONE DEFICIENCY; GROWTH HORMONE RELEASE; HORMONE SUBSTITUTION; HUMAN; HYPERPROLACTINEMIA; HYPOGLYCEMIA; HYPOPHYSIS TUMOR; HYPOPITUITARISM; HYPOTHALAMUS HYPOPHYSIS SYSTEM; INCIDENCE; INSULIN TOLERANCE TEST; LEUKEMIA; LYMPHOMA; NASOPHARYNX CARCINOMA; NEUROTOXICITY; PATHOPHYSIOLOGY; PRECOCIOUS PUBERTY; PRIORITY JOURNAL; PROLACTIN RELEASE; PUBERTY; QUALITY OF LIFE; RADIATION DOSE; RADIATION INJURY; REVIEW; SEXUAL FUNCTION; SKULL BASE TUMOR; SKULL IRRADIATION; THYROTROPIN RELEASE; CHILD; HYPOPHYSIS DISEASE; METABOLISM; METHODOLOGY; RADIOBIOLOGY; SECRETION;

ADRENOCORTICOTROPIC HORMONE; BRAIN NEOPLASMS; CHILD; CRANIAL IRRADIATION; GONADOTROPINS; HUMAN GROWTH HORMONE; HUMANS; HYPOPITUITARISM; PITUITARY DISEASES; PROLACTIN; RADIATION INJURIES; RADIOBIOLOGY; THYROTROPIN;

EID: 66149085268     PISSN: 14217082     EISSN: 16622979     Source Type: Book Series    
DOI: 10.1159/000207607     Document Type: Review

References (97)

1. Withers HR: Biology of radiation oncology; in Tobias JS, Thomas PRM (eds): Current Radiation Oncology. London, Edward Arnold 1994, vol 1, pp 5-23.
2. Schmiegelow M, Lassen S, Poulsen HS, Feldt-Rasmussen U, Schmiegelow K, Hertz H, Muller J: Cranial radiotherapy of childhood brain tumours: growth hormone deficiency and its relation to the biological effective dose of irradiation in a large population based study. Clin Endocrinol 2000;53: 191-197.
3. Darzy KH, Aimaretti G, Wieringa G, Gatta-maneni HR, Ghigo E, Shalet SM: The usefulness of the combined growth hormone (GH)-releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval. J Clin Endocrinol Metab 2003;88:95-102.
4. Agha A, Sherlock M, Brennan S, O'Connor SA, O'Sullivan E, Rogers B, Faul C, Rawluk D, Tormey W, Thompson CJ: Hypothalamic-pituitary dysfunction after irradiation of nonpituitary brain tumors in adults. J Clin Endocrinol Metab 2005; 90:6355-6360.
5. Chieng PU, Huang TS, Chang CC, Chong PN, Tien RD, Su CT: Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients. Am J Neuroradiol 1991;12:661-665.
6. Hochberg Z, Kuten A, Hertz P, Tatcher M, Kedar A, Benderly A: The effect of single-dose radiation on cell survival and growth hormone secretion by rat anterior pituitary cells. Radiat Res 1983;94: 508-512.
7. Robinson IC, Fairhall KM, Hendry JH, Shalet SM: Differential radiosensitivity of hypothalamo-pituitary function in the young adult rat. J Endocrinol 2001;169:519-526.
8. Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, Rubin P: Hypothal amicpituitary dysfunction after radiation for brain tumors. N Engl J Med 1993;328:87-94.
9. Clayton PE, Shalet SM: Dose dependency of time of onset of radiation-induced growth hormone deficiency. J Pediatr 1991;118:226-228.
10. Littley MD, Shalet SM, Beardwell CG, Robinson EL, Sutton ML: Radiation-induced hypopituitarism is dose-dependent. Clin Endocrinol Oxf 1989;31:363-373.
11. Lam KS, Tse VK, Wang C, Yeung RT, Ho JH: Effects of cranial irradiation on hypothalamicpituitary function - a 5-year longitudinal study in patients with nasopharyngeal carcinoma. Q J Med 1991;78:165-176.
12. Duffner PK, Cohen ME, Voorhess ML, MacGillivray MH, Brecher ML, Panahon A, Gilani BB: Long-term effects of cranial irradiation on endocrine function in children with brain tumors. A prospective study. Cancer 1985;56: 2189-2193.
13. Pai HH, Thornton A, Katznelson L, Finkelstein DM, Adams JA, Fullerton BC, Loeffler JS, Leibsch NJ, Klibanski A, Munzenrider JE: Hypothalamic/ pituitary function following high-dose conformal radiotherapy to the base of skull: demonstration of a dose-effect relationship using dose-volume histogram analysis. J Radiat Oncol Biol Phys 2001;49:1079-1092.
14. Samaan NA, Vieto R, Schultz PN, Maor M, Meoz RT, Sampiere VA, Cangir A, Ried HL, Jesse RH Jr: Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck. Int J Radiat Oncol Biol Phys 1982;8:1857-1867.
15. Chen MS, Lin FJ, Huang MJ, Wang PW, Tang S, Leung WM, Leung W: Prospective hormone study of hypothalamic-pituitary function in patients with nasopharyngeal carcinoma after high dose irradiation. Jpn J Clin Oncol 1989;19: 265-270.
16. Sham J, Choy D, Kwong PW, Cheng AC, Kwong DL, Yau CC, Wan KY, Au GK: Radiotherapy for nasopharyngeal carcinoma: shielding the pituitary may improve therapeutic ratio. Int J Radiat Oncol Biol Phys 1994;29:699-704.
17. Ogilvy-Stuart AL, Clark DJ, Wallace WH, Gibson BE, Stevens RF, Shalet SM, Donaldson MD: Endocrine deficit after fractionated total body irradiation. Arch Dis Child 1992;67:1107-1110.
18. Littley MD, Shalet SM, Morgenstern GR, Deakin DP: Endocrine and reproductive dysfunction following fractionated total body irradiation in adults. Q J Med 1991;78:265-274.
19. Brauner R, Czernichow P, Rappaport R: Greater susceptibility to hypothalamopituitary irradiation in younger children with acute lymphoblastic leukemia. J Pediatr 1986;108:332.
20. Samaan NA, Schultz PN, Yang KP, VassilopoulouSellin R, Maor MH, Cangir A, Goepfert H: Endocrine complications after radiotherapy for tumors of the head and neck. J Lab Clin Med 1987;109:364-372.
21. Livesey EA, Hindmarsh PC, Brook CG, Whitton AC, Bloom HJ, Tobias JS, Godlee JN, Britton J:-Endocrine disorders following treatment of childhood brain tumours. Br J Cancer 1990;61:622- 625.
22. Lam KS, Tse VK, Wang C, Yeung RT, Ma JT, Ho JH: Early effects of cranial irradiation on hypothalamic-pituitary function. J Clin Endocrinol Metab 1987;64:418-424.
23. Rose SR, Lustig RH, Pitukcheewanont P, Broome DC, Burghen GA, Li H, Hudson MM, Kun LE, Heideman RL: Diagnosis of hidden central hypothyroidism in survivors of childhood cancer. J Clin Endocrinol Metab 1999;84:4472-4479.
24. Darzy KH, Pezzoli SS, Thorner MO, Shalet SM: Cranial irradiation and growth hormone neuro-secretory dysfunction: a critical appraisal. J Clin Endocrinol Metab 2007;92:1666-1672.
25. Marekova M, Cap J, Vokurkova D, Vavrova J, Cer-man J: Effect of therapeutic doses of ionising radiation on the somatomammotroph pituitary cell line, GH3. Endocr J 2003;50:621-628.
26. Schmiegelow M, Lassen S, Poulsen HS, Feldt-Rasmussen U, Schmiegelow K, Hertz H, Muller J: Growth hormone response to a growth hormonereleasing hormone stimulation test in a population-based study following cranial irradiation of childhood brain tumors. Horm Res 2000;54:53- 59.
27. Achermann JC, Brook CG, Hindmarsh PC: The GH response to low-dose bolus growth hormone-releasing hormone (GHRH(1-29)NH2) is attenuated in patients with longstanding post-irradiation GH insufficiency. Eur J Endocrinol 2000;142:359- 364.
28. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML: Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 1989;70:145-160.
29. Nishioka H, Ito H, Haraoka J, Hirano A: Histological changes in the hypofunctional pituitary gland following conventional radiotherapy for adenoma. Histopathology 2001;38:561-566.
30. Rush S, Cooper PR: Symptom resolution, tumor control, and side effects following postoperative radiotherapy for pituitary macroadenomas. Int J Radiat Oncol Biol Phys 1997;37:1031-1034.
31. Costin G: Effects of low-dose cranial radiation on growth hormone secretory dynamics and hypo-thalamic-pituitary function. Am J Dis Child 1988;142:847-852.
32. Brennan BM, Rahim A, Mackie EM, Eden OB, Shalet SM: Growth hormone status in adults treated for acute lymphoblastic leukaemia in childhood. Clin Endocrinol (Oxf) 1998;48:777-783.
33. Giorgiani G, Bozzola M, Locatelli F, Picco P, Zecca M, Cisternino M, Dallorso S, Bonetti F, Dini G, Borrone C, Regazzi MB, et al: Role of busulfan and total body irradiation on growth of prepubertal children receiving bone marrow transplantation and results of treatment with recombinant human growth hormone. Blood 1995;86:825-831.
34. Brauner R, Adan L, Souberbielle JC, Esperou H, Michon J, Devergie A, Gluckman E, Zucker JM:Contribution of growth hormone deficiency to the growth failure that follows bone marrow transplantation. J Pediatr 1997;130:785-792.
35. Shalet SM, Beardwell CG, Morris-Jones PH, Pearson D: Pituitary function after treatment of intracranial tumours in children. Lancet 1975;2: 104-107.
36. Gleeson HK, Gattamaneni HR, Smethurst L, Brennan BM, Shalet SM: Reassessment of growth hormone status is required at final height in children treated with growth hormone replacement after radiation therapy. J Clin Endocrinol Metab 2004;89:662-666.
37. Shalet SM, Toogood AA, Rahim A, Brennan BMD: The diagnosis of growth hormone deficiency in children and adults. Endocr Rev 1998; 19:203-223.
38. Lustig RH, Schriock EA, Kaplan SL, Grumbach MM: Effect of growth hormone-releasing factor on growth hormone release in children with radiation-induced growth hormone deficiency. Pediatrics 1985;76:274-279.
39. Grossman A, Savage MO, Blacklay A, Ross RM, Plowman PN, Preece MA, Coy DH, Besser GM: The use of growth hormone-releasing hormone in the diagnosis and treatment of short stature. Horm Res 1985;22:52-57.
40. Oberfield SE, Kirkland JL, Frantz A, Allen JC, Levine LS: Growth hormone response to GRF 1-44 in children following cranial irradiation for central nervous system tumors. Am J Pediatr Hematol Oncol 1987;9:233-238.
41. Crosnier H, Brauner R, Rappaport R: Growth hormone response to growth hormone-releasing hormone (hp GHRH1-44) as an index of growth hormone secretory dysfunction after prophylactic cranial irradiation for acute lymphoblastic leukemia (24 grays). Acta Paediatr Scand 1988;77:681-687.
42. Lissett CA, Saleem S, Rahim A, Brennan BM, Shalet SM: The impact of irradiation on growth hormone responsiveness to provocative agents is stimulus dependent: results in 161 individuals with radiation damage to the somatotropic axis. J Clin Endocrinol Metab 2001;86:663-668.
43. Ahmed SR, Shalet SM, Beardwell CG: The effects of cranial irradiation on growth hormone secretion. Acta Paediatr Scand 1986;75:255-260.
44. Romshe CA, Zipf WB, Miser A, Miser J, Sotos JF, Newton WA: Evaluation of growth hormone release and human growth hormone treatment in children with cranial irradiation-associated short stature. J Pediatr 1984;104:177-181.
45. Dickinson W P, Berry DH, Dickinson L, Irvin M, Schedewie H, Fiser RH, Elders MJ: Differential effects of cranial radiation on growth hormone response to arginine and insulin infusion. J Pediatr 1978;92:754-757.
46. Chrousos G P, Poplack D, Brown T, O'Neill D, Schwade J, Bercu BB: Effects of cranial radiation on hypothalamic-adenohypophyseal function: abnormal growth hormone secretory dynamics. J Clin Endocrinol Metab 1982;54:1135-1139.
47. Darzy K, Pezzoli S, Thorner M, Shalet S: The dynamics of GH secretion in adult cancer survivors with severe GH deficiency acquired following brain irradiation in childhood for non- pituitary brain tumors: evidence for preserved pulsatility and diurnal variation with increased secretory disorderliness. J Clin Endocrinol Metab 2005;90:2794-2803.
48. Jessup SK, Malow BA, Symons K V, Barkan AL:Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep. Eur J Endocrinol 2004;151:561-566.
49. Ocampo-Lim B, Guo W, DeMott-Friberg R, Barkan AL, Jaffe CA: Nocturnal growth hormone (GH) secretion is eliminated by infusion of GHreleasing hormone antagonist. J Clin Endocrinol Metab 1996;81:4396-4399.
50. Wehrenberg WB, Brazeau P, Luben R, Bohlen P, Guillemin R: Inhibition of the pulsatile secretion of growth hormone by monoclonal antibodies to the hypothalamic growth hormone releasing factor (GRF). Endocrinology. 1982;111:2147-2148.
51. Sklar CA, Constine LS: Chronic neuroendocrino-logical sequelae of radiation therapy. Int J Radiat Oncol Biol Phys 1995;31:1113-1121.
52. Paakko E, Talvensaari K, Pyhtinen J, Lanning M: Decreased pituitary gland height after radiation treatment to the hypothalamic-pituitary axis evaluated by MR. AJNR Am J Neuroradiol 1994; 15:537-541.
53. Darzy KH, Thorner MO, Shalet SM: Cranially irradiated adult cancer survivors may have normal spontaneous GH secretion in the presence of discordant peak GH responses to stimulation tests (compensated GH deficiency). Clin Endo-crinol 2008; e-pub ahead of print.
54. Kashio Y, Chihara K, Kita T, Okimura Y, Sato M, Kadowaki S, Fujita T: Effect of oral glucose administration on plasma growth hormone-releasing hormone (GHRH)-like immunoreactivity levels in normal subjects and patients with idiopathic GH deficiency: evidence that GHRH is released not only from the hypothalamus but also from extrahypothalamic tissue. J Clin Endocrinol Metab 1987;64:92-97.
55. Masuda A, Shibasaki T, Hotta M, Yamauchi N, Ling N, Demura H, Shizume K: Insulin-induced hypoglycemia, L-dopa and arginine stimulate GH secretion through different mechanisms in man. Regul Pept 1990;31:53-64.
56. Koppeschaar H P, ten Horn CD, Thijssen JH, Page MD, Dieguez C, Scanlon MF: Differential effects of arginine on growth hormone releasing hormone and insulin induced growth hormone secretion. Clin Endocrinol Oxf 1992;36:487- 490.
57. Hanew K, Utsumi A: The role of endogenous GHRH in arginine-, insulin-, clonidine- and L-dopa-induced GH release in normal subjects. Eur J Endocrinol 2002;146:197-202.
58. Giustina A, Veldhuis JD: Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human. Endocr Rev 1998;19:717-797.
59. eldhuis JD, Farhy L, Weltman AL, Kuipers J, Weltman J, Wideman L: Gender modulates sequential suppression and recovery of pulsatile growth hormone secretion by physiological feedback signals in young adults. J Clin Endocrinol Metab 2005;90:2874-2881.
60. Soares-Welch C, Farhy L, Mielke KL, Mahmud FH, Miles JM, Bowers CY, Veldhuis JD: Complementary secretagogue pairs unmask prominent gender-related contrasts in mechanisms of growth hormone pulse renewal in young adults. J Clin Endocrinol Metab 2005;90:2225-2232.
61. Hoeck HC, Vestergaard P, Jakobsen PE, Laurberg P: Test of growth hormone secretion in adults: poor reproducibility of the insulin tolerance test. Eur J Endocrinol 1995;133:305-312.
62. Diamond M P, Jones T, Caprio S, Hallarman L, Diamond MC, Addabbo M, Tamborlane WV, Sherwin RS: Gender influences counterregulatory hormone responses to hypoglycemia. Metabolism 1993;42:1568-1572.
63. Osterman PO, Wide L: The insulin tolerance test after pre-treatment with dexamethasone. Acta Endocrinol Copenh 1976;83:341-356.
64. Biller BM, Samuels MH, Zagar A, Cook DM, Arafah BM, Bonert V, Stavrou S, Kleinberg DL, Chip-man JJ, Hartman ML: Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab 2002;87: 2067- 2079.
65. Merimee TJ, Rabinowtitz D, Fineberg SE: Arginine-initiated release of human growth hormone. Factors modifying the response in normal man. N Engl J Med 1969;280:1434-1438.
66. Blatt J, Lee P, Suttner J, Finegold D: Pulsatile growth hormone secretion in children with acute lymphoblastic leukemia after 1800 cGy cranial radiation. Int J Radiat Oncol Biol Phys 1988;15:1001-1006.
67. Crowne EC, Moore C, Wallace WH, Ogilvy-Stuart AL, Addison GM, Morris-Jones PH, Shalet SM: A novel variant of growth hormone (GH) insufficiency following low dose cranial irradiation. Clin Endocrinol (Oxf) 1992;36:59-68.
68. Stubberfield TG, Byrne GC, Jones TW: Growth and growth hormone secretion after treatment for acute lymphoblastic leukemia in childhood. 18-Gy versus 24-Gy cranial irradiation. J Pediatr Hematol Oncol 1995;17:167-171.
69. Lannering B, Rosberg S, Marky I, Moell C, Albertsson-Wikland K: Reduced growth hormone secretion with maintained periodicity following cranial irradiation in children with acute lymphoblastic leukaemia. Clin Endocrinol (Oxf) 1995;42:153-159.
70. Blatt J, Bercu BB, Gillin JC, Mendelson WB,. Poplack DG: Reduced pulsatile growth hormone secretion in children after therapy for acute lym-phoblastic leukemia. J Pediatr 1984;104:182-186.
71. Moell C, Garwicz S, Westgren U, Wiebe T, Albertsson-Wikland K: Suppressed spontaneous secretion of growth hormone in girls after treatment for acute lymphoblastic leukaemia. Arch Dis Child 1989;64:252-258.
72. Ryalls M, Spoudeas HA, Hindmarsh PC, Matthews DR, Tait DM, Meller ST, Brook CG: Shortterm endocrine consequences of total body irradiation and bone marrow transplantation in children treated for leukemia. J Endocrinol 1993; 136:331-338.
73. Spoudeas HA, Hindmarsh PC, Matthews DR, Brook CG: Evolution of growth hormone neurosecretory disturbance after cranial irradiation for childhood brain tumours: a prospective study. J Endocrinol 1996;150:329-342.
74. Lannering B, Albertsson-Wikland K: Growth hormone release in children after cranial irradiation. Horm Res 1987;27:13-22.
75. Moell C: Disturbed pubertal growth in girls after acute leukaemia: a relative growth hormone insufficiency with late presentation. Acta Paediatr Scand Suppl 1988;343:162-166.
76. Pasqualini T, Escobar ME, Domene H, Muriel FS, Pavlovsky S, Rivarola MA: Evaluation of gonadal function following long-term treatment for acute lymphoblastic leukemia in girls. Am J Pediatr Hematol Oncol 1987;9:15-22.
77. Sanders JE, Buckner CD, Leonard JM, Sullivan KM, Witherspoon R P, Deeg HJ, Storb R, Thomas ED: Late effects on gonadal function of cyclophosphamide, total-body irradiation, and marrow transplantation. Transplantation 1983;36:252-255.
78. Rappaport R, Brauner R, Czernichow P, Thibaud E, Renier D, Zucker JM, Lemerle J: Effect of hypothalamic and pituitary irradiation on pubertal development in children with cranial tumors. J Clin Endocrinol Metab 1982;54:1164-1168.
79. Yoshimoto Y, Moridera K, Imura H: Restoration of normal pituitary gonadotropin reserve by administration of luteinizing-hormone-releasing hormone in patients with hypogonadotropic hypogonadism. N Engl J Med 1975;292:242-245.
80. Hall JE, Martin KA, Whitney HA, Landy H, Crowley WF Jr: Potential for fertility with replacement of hypothalamic gonadotropin-releasing hormone in long term female survivors of cranial tumors. J Clin Endocrinol Metab 1994;79:1166- 1172.
81. Brauner R, Rappaport R: Precocious puberty secondary to cranial irradiation for tumors distant from the hypothalamo-pituitary area. Horm Res 1985;22:78-82.
82. Leiper AD, Stanhope R, Kitching P, Chessells JM:Precocious and premature puberty associated with treatment of acute lymphoblastic leukaemia. Arch Dis Child 1987;62:1107-1112.
83. Ogilvy-Stuart AL, Clayton PE, Shalet SM: Cranial irradiation and early puberty. J Clin Endocrinol Metab 1994;78:1282-1286.
84. Lannering B, Jansson C, Rosberg S, Albertsson-Wikland K: Increased LH and FSH secretion after cranial irradiation in boys. Med Pediatr Oncol 1997;29:280-287.
85. Quigley C, Cowell C, Jimenez M, Burger H, Kirk J, Bergin M, Stevens M, Simpson J, Silink M: Normal or early development of puberty despite gonadal damage in children treated for acute lymphoblastic leukemia. N Engl J Med 1989;321:143- 151.
86. Roth C, Schmidberger H, Schaper O, Leonhardt S, Lakomek M, Wuttke W, Jarry H: Cranial irradiation of female rats causes dose-dependent and age-dependent activation or inhibition of puber-tal development. Pediatr Res 2000;47:586-591.
87. Roth C, Lakomek M, Schmidberger H, Jarry H:Cranial irradiation induces premature activation of the gonadotropin-releasing-hormone (in German). Klin Pädiatr 2001;213:239-243.
88. Adan L, Sainte-Rose C, Souberbielle JC, Zucker JM, Kalifa C, Brauner R: Adult height after growth hormone (GH) treatment for GH deficiency due to cranial irradiation. Med Pediatr Oncol 2000;34:14-19.
89. Gleeson HK, Stoeter R, Ogilvy-Stuart AL, Gatta-maneni HR, Brennan BM, Shalet SM: Improvements in final height over 25 years in growth hormone (GH)-deficient childhood survivors of brain tumors receiving GH replacement. J Clin Endocrinol Metab 2003;88:3682-3689.
90. Rose SR, Lustig RH, Burstein S, Pitukcheewanont P, Broome DC, Burghen GA: Diagnosis of ACTH deficiency. Comparison of overnight metyrapone test to either low-dose or high-dose ACTH test. Horm Res 1999;52:73-79.
91. Darzy KH, Shalet SM: Absence of adrenocorticotropin (ACTH) neurosecretory dysfunction but increased cortisol concentrations and production rates in ACTH-replete adult cancer survivors after cranial irradiation for nonpituitary brain tumors. J Clin Endocrinol Metab 2005;90:5217- 5225.
92. Mohn A, Chiarelli F, Di Marzio A, Impicciatore P, Marsico S, Angrilli F: Thyroid function in children treated for acute lymphoblastic leukemia. J Endocrinol Invest 1997;20:215-219.
93. Lando A, Holm K, Nysom K, Rasmussen AK, Feldt-Rasmussen U, Petersen JH, Muller J: Thyroid function in survivors of childhood acute lymphoblastic leukaemia: the significance of prophylactic cranial irradiation. Clin Endocrinol 2001;55:21-25.
94. Carter E P, Leiper AD, Chessells JM, Hurst A:Thyroid function in children after treatment for acute lymphoblastic leukaemia. Arch Dis Child 1989;64:631.
95. Oberfield SE, Sklar C, Allen J, Walker R, Mcelwain M, Papadakis V, Maenza J: Thyroid and gonadal function and growth of long-term survivors of medulloblastoma/PNET; in Green DM, D'Angio GJ (eds): Late Effects of Treatment for Childhood Cancer. New York, Wiley-Liss, 1992, pp 55-62.
96. Schmiegelow M, Feldt-Rasmussen U, Rasmussen AK, Poulsen HS, Muller J: A population-based study of thyroid function after radiotherapy and chemotherapy for a childhood brain tumor. J Clin Endocrinol Metab 2003;88:136-140.
97. Darzy KH, Shalet SM: Circadian and stimulated thyrotropin secretion in cranially irradiated adult cancer survivors. J Clin Endocrinol Metab 2005; 90:6490-6497.