2018 Volume 121 Issue 12 Pages 1499-1505
Radiation-induced hypopituitarism (RIH) is a late adverse effect of intracranial irradiation. Recently, reports of cases of RIH after radiation therapy for head and neck cancer have increased, owing to improvements in the survival rates of the patients. In this paper, we report the case of a patient in whom RIH developed 13 years after radiation therapy for nasopharyngeal cancer.
A 53-year-old man who had received chemoradiation therapy for nasopharyngeal carcinoma (T4N1M0, squamous cell carcinoma) at the age of 40 years visited our department 9 years after completion of the therapy for the purpose of follow-up. At the end of 4 years of follow-up, the patient developed a right infratemporal fossa abscess secondary to radiation-induced osteonecrosis of the right greater wing of the sphenoid. Even after surgical drainage and antibiotic therapy, the patient remained in shock, failing to respond to even pressor therapy with noradrenaline. Since the patient was abnormally inertia from the first visit, hormone deficiency was suspected and the patient was eventually diagnosed as having adrenal and thyroid insufficiency. Hormone supplementation was started, and not only did the patient recover from the shock state, but also his mental state and intelligence were restored. The patient was discharged on oral hydrocortisone and levothyroxine after 149 days of hospitalization.
Since RIH is a progressive and irreversible condition, long-term follow up and timely hormone supplementation are recommended after irradiation of the skull base. Further accumulation of evidence is needed.
