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Late Effects Case Presentation PowerPoint PPT Presentation


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Late Effects Case Presentation. Exeter Sept 2008. 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. Ms JW. First presented late effects clinic 06/2005 No complaints

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Late Effects Case Presentation

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Late effects case presentation l.jpg

Late Effects Case Presentation

Exeter Sept 2008


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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


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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”


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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


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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


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Ms J W

  • Started on T4 100mcgs

  • SST needed

  • Short synacthen test performed

  • 0mins) 222 nmol/L

  • 30mins) 572nmol/L


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Ms J W

  • September 2006

  • T4 duration 5 weeks

  • Reported increased energy levels

  • Weight decreased 3kgs

  • “Feeling great”

  • AGHDA 21/25


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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


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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


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MR


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MR


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MR


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Ms J W

Craniotomy and resection of tumour

January 2008

Neuropathology meningioma WHO

grade 1

Radiotherapy referral


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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


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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


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