Chiara Mele, Stella Pigni, Marina Caputo, Maria Francesca Birtolo, Carola Ciamparini, Gherardo Mazziotti, Andrea Gerardo Antonio Lania, Paolo Marzullo, Flavia Prodam, Gianluca Aimaretti
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引用次数: 0
Abstract
Both local and external cranial radiotherapy (RT) can induce neurotoxicity and vascular damage of the hypothalamic-pituitary area, which can promote neuroendocrine alterations. While anterior pituitary insufficiency after RT has been extensively characterized, data on the effect of RT on prolactin (PRL) secretion are limited and heterogeneous, with different patterns of PRL behavior described in the literature. A progressive decline in PRL levels, reflecting a time-dependent, slowly evolving radiation-induced damage to the pituitary lactotroph cells has been reported. To date, the association between hypopituitarism and hypoprolactinemia in patients undergoing RT has not yet been fully investigated. The few available data suggest that lower PRL levels can predict an extent damage of the pituitary tissue and a higher degree of hypothalamic dysfunction. However, most studies on the effect of RT on pituitary function do not properly assess PRL secretion, as PRL deficiency is usually detected as part of hypopituitarism and not systematically investigated as an isolated disorder, which may lead to an underestimation of hypoprolactinemia after RT. In addition, the often-inadequate follow-up over a long period of time may contribute to the non-recognition of PRL deficiency after RT. Considering that hypoprolactinemia is associated with various metabolic complications, there is a need to define appropriate diagnostic and management criteria. Therefore, hypoprolactinemia should enter in the clinical investigation of patients at risk for hypopituitarism, mainly in those patients who underwent RT.
局部放疗和颅外放疗(RT)都会引起下丘脑-垂体区域的神经毒性和血管损伤,从而促进神经内分泌的改变。RT后垂体前叶功能不全已被广泛描述,但有关RT对催乳素(PRL)分泌影响的数据却很有限,且存在差异,文献中描述的PRL行为模式也不尽相同。有报道称,PRL 水平会逐渐下降,这反映了辐射对垂体泌乳细胞造成的损伤是随时间缓慢发展的。迄今为止,尚未对接受 RT 治疗的患者中垂体功能减退症与低泌乳素血症之间的关联进行全面研究。现有的少量数据表明,较低的 PRL 水平可预示垂体组织的损伤程度和较高程度的下丘脑功能障碍。然而,大多数有关 RT 对垂体功能影响的研究都没有正确评估 PRL 分泌,因为 PRL 缺乏通常是作为垂体功能减退症的一部分检测出来的,而不是作为一种孤立的疾病进行系统研究,这可能会导致低泌乳素血症在 RT 后被低估。此外,长期随访不足也可能导致 RT 后 PRL 缺乏症未被发现。考虑到低泌乳素血症与各种代谢并发症相关,有必要定义适当的诊断和管理标准。因此,低泌乳素血症应被纳入垂体功能减退症高危患者的临床调查中,主要是那些接受过RT治疗的患者。
期刊介绍:
Reviews in Endocrine and Metabolic Disorders is an international journal dedicated to the field of endocrinology and metabolism. It aims to provide the latest advancements in this rapidly advancing field to students, clinicians, and researchers. Unlike other journals, each quarterly issue of this review journal focuses on a specific topic and features ten to twelve articles written by world leaders in the field. These articles provide brief overviews of the latest developments, offering insights into both the basic aspects of the disease and its clinical implications. This format allows individuals in all areas of the field, including students, academic clinicians, and practicing clinicians, to understand the disease process and apply their knowledge to their specific areas of interest. The journal also includes selected readings and other essential references to encourage further in-depth exploration of specific topics.