1 / 16

Late Effects Case Presentation

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

Thomas
Download Presentation

Late Effects Case Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Late Effects Case Presentation Exeter Sept 2008

  2. 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

  3. 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”

  4. 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

  5. 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

  6. Ms J W • Started on T4 100mcgs • SST needed • Short synacthen test performed • 0mins) 222 nmol/L • 30mins) 572nmol/L

  7. Ms J W • September 2006 • T4 duration 5 weeks • Reported increased energy levels • Weight decreased 3kgs • “Feeling great” • AGHDA 21/25

  8. 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

  9. 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

  10. MR

  11. MR

  12. MR

  13. Ms J W Craniotomy and resection of tumour January 2008 Neuropathology meningioma WHO grade 1 Radiotherapy referral

  14. 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

  15. 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

More Related