Multiple thyroid carcinoma and other long-term endocrine consequences of chemoradiotherapy for medulloblastoma: a clinical case

Background. Due to the achievements of modern medicine, the survival rate of patients after complex therapy of malignant brain tumors, including medulloblastoma, the most common solid malignant tumor of childhood, has significantly increased in recent years. Description of the clinical case. Patient Z., 21 years old. Medulloblastoma was diagnosed at 6 years of age. Surgical removal of the tumor, radiation and polychemotherapy were performed. After polychemotherapy, sensorineural hearing loss developed. In the Clinic of Endocrinology of the Sechenov University, the patient was diagnosed with multiple endocrine disorders. Somatotropic insufficiency was confirmed by the results of the test with glucagon: growth hormone <0.05 ng/ml at all points of the study; hypocorticism was excluded during the test with 1-24 ACTH (initial cortisol - 521 nmol/l [119-618], stimulated cortisol - 1200 nmol/l [119-618]); patient was diagnosed with type 2 diabetes mellitus: HbA1c - 7.4%, glycemia 16.9 mmol/l, negative antibodies specific for autoimmune diabetes mellitus (to pancreatic в-cells, insulin, glutamate decarboxylase, tyrosine phosphatase); preserved reserve of pancreatic в-cells. Thyroid ultrasonography and subsequent fine needle aspiration biopsy revealed left and right lobe nodules suspicious of papillary cancer (Bethesda V). Postoperative histological examination revealed papillary and follicular thyroid cancers. Data for postoperative hypoparathyroidism was not obtained, levothyroxine was prescribed in a suppressive dose. The patient continues follow-up at the endocrinology clinic. Conclusion. Considering the prevalence of endocrine and metabolic disorders after complex treatment of malignant brain tumors, timely detection of pathology and compensation of endocrine consequences is necessary.

medulloblastoma, thyroid cancer, growth hormone deficiency, hypocorticism, diabetes mellitus