Endocrine Abstracts

Long-term sequels of pituitary radiotherapy include hypopituitarism, optic nerve atrophy, sensorineural hearing loss, neurocognitive impairment and second intracranial neoplasms, the meningioma being the most frequent. The cumulative incidence of second cerebral tumours within 20 years of the radiation is 2% and, unlike its primary forms, they show a more aggressive atypical histology, and the age of appearance varies depending on the latency time, which in its turn is proportional to the dose of received radiation.

Material and methods: We present three patients with meningiomas secondary to pituitary adenoma radiation, all of them of somatomammotroph lineage. All these meningiomas were developed on the area of pituitary irradiation, over 20 years after it, and they were neither present on the diagnose nor was there an environmental or genetic proneoplastic condition.

Results: Case 1: A 65-year-old man, diagnosed with macroprolactinoma on 1977. He received cobalt therapy after a subtotal resection of the tumour. He debuted 29 years later with fronto-orbital cephalea in relation with a prebulbar meningioma with extension to the foramen magnum.

Case 2: A 72-year-old male diagnosed with GH releasing macroadenoma in 1968. He was treated with cobalt-therapy and 44 years later presented with apathy and bradypsychia. Neuroimaging revealed the presence of a right frontal convexity meningioma.

Case 3: A 50-year-old man, diagnosed with a macroprolactinoma on 1973 and treated with radiotherapy. After 40 years of treatment, a 1′1 cm meningioma is discovered on the right sylvian fissure following a study of dementia due to memory loss, mental dispersion, and depressed mood. The total dose of radiation received was 40–50 Gy on each patient.

Conclusions: Second cerebral neoplasms may appear more than 30 years after the pituitary radiotherapy and its detection advices permanent monitoring in neuroendocrinology consultations by means of periodic neuroimaging studies.