ReviewClinical and translational radiation oncology2025
Radiotherapy-induced Hypothalamic-Pituitary axis dysfunction in adult Brain, head and neck and skull base tumor patients - A systematic review and Meta-Analysis.
Review in Clinical and translational radiation oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Delayed Hypothalamic Dysfunction Presenting as Recurrent Hypothermia After Treatment of Suprasellar Germinoma: A Case Report.Clinical case reports · 2026Article
- Predicting late radiation-associated neurocognitive and endocrine toxicity in patients with brain tumors.Journal of neuro-oncology · 2026Article
- Trade-offs in proton and photon radiotherapy for pituitary adenomas.Physics and imaging in radiation oncology · 2026Article
- CAI Score for the Diagnosis of Central Adrenal Insufficiency.Journal of the Endocrine Society · 2026Article
- Management of Acquired Hypothalamic Dysfunction and the Hypothalamic Syndrome; It Is More Than Obesity.Endocrine reviews · 2025Review
- An overview of hypopituitarism's causes.Frontiers in endocrinology · 2025Review
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Authors and funding
9 authors.
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Abstract
Background and purpose: Radiotherapy for brain, head & neck (HN), and skull base (SB) tumors may deliver significant radiation dose to the hypothalamic-pituitary axis (HPA), leading to impaired functioning of this region and hence, to endocrine disorders. The purpose of this systematic review and Materials and methods: Literature search of the PubMed database was performed for HP dysfunction after radiotherapy in adult patients. A risk of bias assessment was performed to rate the quality of the included papers. Besides clinical and treatment variables, reported insufficiencies for adrenocorticotrophic hormone, thyroid stimulating hormone, growth hormone, prolactin and follicle stimulating hormone and luteinizing hormone and for insufficiency of any axis were extracted. The prevalence for hormonal insufficiency per axis and for multiple axes was calculated using a random effects Results: The literature selection process resulted in a total of 22 original papers, suitable for full assessment (n = 1,462 patients). Literature showed a wide variation in HP dysfunction, along with wide dose ranges given to the hypothalamus and pituitary, with varying follow-up times. The calculated prevalence for any pituitary insufficiency was on average 0.61 (95 % CI 0.44-0.75). For growth hormone the mean prevalence was 0.40 (95 % CI 0.22-0.61), for prolactin 0.22 (95 % CI 0.17-0.28), for gonadotropin 0.20 (95 % CI 0.14-0.28), for adrenocorticotropic hormone 0.16 (95 % CI 0.08-0.30) and for thyroid stimulating hormone 0.16 (95 % CI 0.11-0.23). The prevalence for any insufficiency of 1 axis was 0.19 (95 % CI 0.11-0.30), of 2 axes 0.22 (95 % CI 0.12-0.38), of 3 axes 0.05 (95 % CI 0.03-0.09) and of panhypopituitarism 0.17 (95 % CI 0.08-0.32). Patients irradiated for nasopharyngeal carcinoma (NPC) seemed to be at highest risk for developing any endocrine insufficiency with a mean prevalence of 0.68 (95 % CI 0.45-0.85). A significant correlation between any endocrine insufficiency and follow-up time was observed (p = 0.015). A correlation between dose to the pituitary and occurrence of insufficiency on the hormonal axes could not be observed. Conclusion: Endocrine insufficiency is reported in over half of the patients irradiated for brain, HN and SB malignancies. The hypothalamus is likely to be more vulnerable to radiation dose compared to the pituitary gland. More research is needed to establish dose thresholds for the hypothalamus and the pituitary to minimize the risk for pituitary insufficiency. Based on this knowledge, radiotherapy and follow-up of these patient groups should be standardized to establish a normal tissue complication probability (NTCP) model for the HPA.
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