Chapter 61 • Endocrine dysfunction may occur as a direct result of cancer or may be a consequence of cancer therapy (e.g., surgery, radiation, chemotherapy, biological agents, and hormone therapy). Endocrine dysfunction may be an intentional consequence or an adverse effect of antineoplastic therapy. • Hypopituitarism with clinically significant deficiencies of growth hormone, thyrotropin, gonadotropin, and corticotrophin may result from radiation (cranial or total body irradiation), surgery, or chemotherapy. • Thyroid dysfunction from neck irradiation, immune therapy (interleukin-2), and small molecule tyrosine kinase inhibitors such as sunitinib may result in either hyperthyroidism or hypothyroidism. • Gonadal dysfunction after surgery, radiotherapy, or chemotherapy results in disruption of puberty, infertility, and premature menopause. • Adrenal dysfunction from agents such as ketoconazole or aminoglutethimide may result in glucocorticoid or mineralocorticoid deficiency. • Pancreatitis and, occasionally, pancreatic exocrine or endocrine deficiencies may result from chemotherapy (l-asparaginase and streptozotocin). • A detailed history along with a complete physical examination is critical for diagnosis. Locations of primary and metastatic tumors along with past and current therapies are necessary elements of evaluation. • Signs and symptoms such as delayed or precocious puberty, fatigue, weight loss or gain, amenorrhea, orthostatic hypotension, hyperpigmentation, or electrolyte abnormalities should prompt consideration of unrecognized endocrine dysfunction. • When one hormonal deficiency is identified, others should be sought. • Primary hypothyroidism is characterized by a low free thyroxine (T4) level and an elevated thyroid-stimulating hormone (TSH) level, whereas central hypothyroidism is associated with a low free T4 level and inappropriately normal or low TSH levels. Replacement with levothyroxine is indicated and is highly effective.
Endocrine Complications
Summary of Key Points
Introduction
Diagnostic Considerations
Evaluation and Treatment
Thyroid
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