Stress Axis in the Cancer Patient: Clinical Aspects and Management

Endocrines

Nervo Alice¹  Rosso Daniela¹  Arvat Emanuela¹  Brignardello Enrico²  Gatti Filippo²  Felicetti Francesco² 

[1] Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy;Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, 10126 Turin, Italy;

关键词: hypothalamus-pituitary-adrenal axis;    adrenal insufficiency;    adverse event;    cancer survivors;    chemotherapy;    radiotherapy;   

DOI  :  10.3390/endocrines2040044

来源: DOAJ

【 摘 要 】

Hypothalamus–pituitary–adrenal (HPA) axis alterations are common in cancer patients, mainly due to the different antitumoral therapies, which lead to several acute and late endocrine side effects. This review summarizes the most recent evidence regarding HPA derangement, both in patients with active neoplasms and in cancer survivors, with particular attention to the impact of the different antitumoral treatments, focusing on the major clinical aspects. While acute hormone failure usually results from injury caused directly by tumor burden or surgical interventions, short- and long-term effects are generally due to chemotherapy, radiotherapy and, as more recently shown, to different types of targeted- and immuno-therapy. Adrenal insufficiency (AI) is mostly caused by pituitary or hypothalamic injury rather than a direct damage of the adrenal gland. Moreover, other treatments commonly employed as supportive therapy or in the context of palliative care (i.e., glucocorticoids, opioids) can lead to HPA dysfunction. Epidemiology and pathophysiology of stress axis alterations in cancer patients still require clarification. Since AI may represent a life-threatening condition, monitoring adrenal function in cancer patients is mandatory, especially in subjects who experience fatigue or during stress conditions, in order to promptly start replacement treatment when needed.

【 授权许可】

Unknown