Sixteen years post radiotherapy of nasopharyngeal carcinoma elicited multi-dysfunction along PTX and chronic kidney disease with microcytic anemia

BMC Urology

Case Report

Chia-Chun Huang¹  Yi-Ting Lin²  Kuan-Chou Chen³  Charng-Cherng Chyau⁴  Robert Y Peng⁴ 

[1] Department of Radiation Oncology, Changhua Christian Hospital, No.135 Nan Shiau Street, 500, Changhua, Taiwan;Department of Urology, St. Joseph’s Hospital, 74, Sinsheng Road, 632, Huwei County, Yunlin Hsien, Taiwan;Research Institute of Biotechnology, Hungkuang University, 34 Chung-Chie Road, Shalu County, 43302, Taichung City, Taiwan;Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei Medical University, 250, Wu-Xin St, Xin-Yi District, 110, Taipei, Taiwan;Department of Urology, School of Medicine, Taipei Medical University, 250, Wu-Xin St, Xin-Yi District, 110, Taipei, Taiwan;Research Institute of Biotechnology, Hungkuang University, 34 Chung-Chie Road, Shalu County, 43302, Taichung City, Taiwan;

关键词: Radiotherapy;    Hypopituitarism;    Hypothyroidism;    Hypogonadism;    Adrenal insufficiency;    Chronic kidney disease;    Microcytic anemia;   

DOI  :  10.1186/1471-2490-14-19

 received in 2013-10-13, accepted in 2014-01-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThe hypothalamic–pituitary (h-p) unit is a particularly radiosensitive region in the central nervous system. As a consequence, radiation-induced irreversible, progressively chronic onset hypopituitarism (RIH) commonly develops after radiation treatments and can result in variably impaired pituitary function, which is frequently associated with increased morbidity and mortality.Case presentationA 38-year-old male subject, previously having received radiotherapy for treatment of nasopharygeal carcinoma (NPCA) 16 years ago, appeared at OPD complaining about his failure in penile erection, loss of pubic hair, atrophy of external genitalia: testicles reduced to 2×1.5 cm; penile size shrunk to only 4 cm long. Characteristically, he showed extremely lowered human growth hormone, (HGH, 0.115 ng/mL), testosterone (<0.1 ng/mL), total thyroxine (tT4: 4.740 g/mL), free T4 (fT4, 0.410 ng/mL), cortisol (2.34 g/dL); lowered LH (1.37 mIU/mL) and estradiol (22 pg/mL); highly elevated TSH (7.12 IU/mL). As contrast, he had low end normal ACTH, FSH, total T3, free T3, and estriol; high end normal prolactin (11.71 ng/mL), distinctly implicating hypopituitarism-induced hypothyroidism and hypogonadism. serologically, he showed severely lowered Hb (10.6 g/dL), HCT (32.7%), MCV (77.6 fL), MCH (25.3 pg), MCHC (32.6 g/dL), and platelet count (139×103/L) with extraordinarily elevated RDW (18.2%), together with severely lowered ferritin (23.6 ng/mL) and serum iron levels; highly elevated total iron binding capacity (TIBC, 509 g/dL) and transferrin (363.4 mg/dL), suggesting microcytic anemia. Severely reduced estimated glomerular filtration rate (e-GFR) (89 mL/mim/1.73 m2) pointed to CKD2. Hypocortisolemia with hyponatremia indicated secondary adrenal insufficiency. Replacement therapy using androgen, cortisol, and Ringer’s solution has shown beneficial in improving life quality.ConclusionsTo our believe, we are the first group who report such complicate PTX dysfunction with adrenal cortisol insufficiency concomitantly occurring in a single patient.

【 授权许可】

Unknown   
© Lin et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.