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Radiotherapy-induced hypopituitarism — SCE Endocrinology MCQ

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HardPituitaryRadiotherapy-induced hypopituitarismSCE Endocrinology

A 57-year-old man has fatigue, low libido and central adiposity after cranial radiotherapy for nasopharyngeal cancer. Testosterone is low with low LH, IGF-1 is low and 09:00 cortisol is 160 nmol/L. What is the most appropriate next investigation?

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Correct answer: E — Dynamic assessment of the hypothalamic-pituitary-adrenal axis

Prior cranial radiotherapy can cause evolving hypopituitarism; possible ACTH deficiency needs dynamic assessment when basal cortisol is indeterminate. TSH alone is inadequate because central hypothyroidism requires free T4 interpretation. The pearl is that pituitary deficiencies after radiotherapy may develop years later.

Reference: Society for Endocrinology hypopituitarism guidance