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Late Effects Case Presentation

Late Effects Case Presentation

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Late Effects Case Presentation

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  1. Late Effects Case Presentation Exeter Sept 2008

  2. Ms J W • Diagnosed Acute Lymphoblastic Leukaemia 1981 aged 5 yrs • UKALL X protocol 1981-1984 BCH • 18 Gy prophylactic cranial irradiation • Chemotherapy but no anthracyclines

  3. Ms JW • First presented late effects clinic 06/2005 • No complaints • No hormone replacement • 4 months Post Partum • Offered anterior pituitary function test • T4 TSH “normal”

  4. Ms J W • Need for testing?? • 58% have one or more medical problem • 32% have two or more medical problems • 41% have an endocrine disorder • Stevens et al 1998 Eur J can 34:694

  5. Ms J W • Glucagon 1/07/2006 • Pk GH <1.0 mU/L • Pk Cortisol 311 nmol/L • IGF1 34.8 nmol/L (14-48) • Borderline TFT’s • Ft4 9.7pmol/L • TSH 4.98mU/L • AGHDA 19/25

  6. Ms J W • Started on T4 100mcgs • SST needed • Short synacthen test performed • 0mins) 222 nmol/L • 30mins) 572nmol/L

  7. Ms J W • September 2006 • T4 duration 5 weeks • Reported increased energy levels • Weight decreased 3kgs • “Feeling great” • AGHDA 21/25

  8. Ms J W • Glucagon 16/02/2007 • Pk Cortisol 286 nmol/L • Pk GH 5.5 mIU/L (baseline) • C/o profound lethargy • Started on hydrocortisone daily dose 10mgs/5mgs

  9. Ms J W • June 2007 • c/o profound fatigue • Headaches normally afternoons • Ringing inner ears • IGF1 increased to 51nmol/L (13-37) • CT head large atypical looking meningioma

  10. MR

  11. MR

  12. MR

  13. Ms J W Craniotomy and resection of tumour January 2008 Neuropathology meningioma WHO grade 1 Radiotherapy referral

  14. Ms J W • March 2008 • Extremely well • No headaches • See September with follow up scans • Continues hydrocortisone 10/5mgs • T4 100mcgs • Irregular periods • Sex steroids

  15. Ms J W Summary • Late Effects!! • Secondary tumours following prophylactic cranial irradiation • Progressive hypopituitarism rarely observed at lose radiation dose • Endocrinopathy • 2 failed glucagons V normal/high IGF1 • Normal SST • Borderline AST