Cancer-Related Neuroendocrine Dysfunction

Neuroendocrine dysfunction is a major side effect of cancer and its treatment. Hormonal and metabolic abnormalities can profoundly affect the well-being of patients and even threaten their lives.

Often, neuroendocrine abnormalities last only as long as a particular treatment (e.g., exogenous hypercortisolism in patients treated with glucocorticoids). In other cases, the impact may be prolonged, either because an indolent tumor continues to contribute to certain abnormalities (e.g., hypercalcemia in some patients with islet cell tumors) or because the effects of the treatment may linger for several years (e.g., hypothalamic or pituitary dysfunction after cranial irradiation).

Some tumors are associated with paraneoplastic syndromes; ectopic hormone secretion, for example, may activate osteoclasts in the skeleton (resulting in hypercalcemia) or stimulate cortisol secretion from the adrenal glands (resulting in Cushing’s syndrome). In other patients, antineoplastic therapy affects the normal function of endocrine glands and causes hormone deficiencies that increase morbidity and interfere with the patient’s ability to tolerate cancer treatment. The early detection and correction of such side effects is needed to optimize patient outcomes.

Patients who have been treated with cranial irradiation, in particular, require prolonged surveillance because the deleterious effects of irradiation may not become apparent for many years. A comprehensive review of the patient’s oncologic history is needed at the completion of therapy to design an appropriate surveillance strategy.

In children who have undergone cranial irradiation, growth should be monitored closely. For children who do not grow as expected, growth hormone replacement therapy is effective. In children eight to 10 years old, particular attention should focus on delayed or precocious puberty. In children with documented growth hormone or gonadal dysregulation, bone mineral density should also be evaluated.

In adults, detection of hypothalamic or pituitary abnormalities is more challenging. One strategy is to screen routinely for the integrity of the growth hormone axis (serum insulin-like growth factor-1 level) and the hypothalamic or pituitary gonadal axis (menstrual and sexual history or hormone levels). Physical examination should focus on signs of pituitary dysfunction such as loss of axillary or pubic hair, fine wrinkling of the skin, and adipose tissue redistribution. Advanced age and hypopituitarism are risk factors for osteoporosis in adults of either sex; thus, periodic bone mineral density measurement, nutritional counseling, and lifestyle education are very important.

Careful surveillance is particularly important because effective treatments are available for most neuroendocrine abnormalities.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call the M. D. Anderson Information Line at (800) 392-1611 (in the United States) or (713) 792-3245 (in Houston and outside the United States).

Other articles in OncoLog, September 2004 issue:

• New Approaches to Managing Tumors of the Pituitary Gland Offer Patients Hope
• Needleless Chemotherapy: Safety and Efficacy of Aerosolized Chemotherapy Being Studied in Young Patients with Cancer
• M. D. Anderson Physician Honored for Inventing an Antimicrobial Catheter That Prevents 25,000 Infection-Related Deaths a Year
• House Call: How Cancer Happens and Ways to Lower Your Risk

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