{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:31:20Z","timestamp":1787059880899,"version":"build-2736575974"},"reference-count":10,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":93,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Adult medulloblastoma is a rare cerebellar tumour with an incidence of 0.6\u20131 per million per year in post-pubertal patients. Craniospinal radiotherapy is a key component of treatment. Endocrine organs commonly involved in the radiation field \u2013 such as the hypothalamus, pituitary and thyroid gland \u2013 are particularly sensitive to radiation-induced damage, often resulting in hormonal deficiencies in a dose-dependent manner. We report the case of a 43-year-old woman who developed both hypopituitarism and primary hypothyroidism following craniospinal radiotherapy for medulloblastoma at the age of 34. She was diagnosed with primary hypothyroidism two years later. Seven years later, hormonal substitution therapy was started for menopausal symptoms, and nine years later, she presented with persisting long-standing fatigue, amenorrhoea, nausea upon waking, vomiting and anorexia. Laboratory testing was suggestive of hypopituitarism. Dynamic testing confirmed severe growth hormone deficiency but a normal cortisol response. Thyroid-releasing hormone stimulation test revealed a blunted and delayed response. Magnetic resonance imaging revealed significantly reduced pituitary height over time. Although radiation-induced endocrine dysfunction is well documented in children, its prevalence in adult populations also reaches 50%, and its clinical significance is increasingly recognised. Despite the common occurrence of hypothalamic\u2013pituitary axis dysfunction and primary hypothyroidism following craniospinal irradiation, their simultaneous presentation provides an important educational example of the complex and multifaceted endocrine effects of radiation exposure. This paper highlights the importance of minimising radiation dose on these endocrine glands, as well as long-term multidisciplinary follow-up and screening after craniospinal radiotherapy. It also raises the question whether pituitary evaluation on surveillance imaging could help predict pituitary dysfunction, a possibility that warrants further exploration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0143","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T12:19:15Z","timestamp":1780575555000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Recognising pituitary and thyroid dysfunction after craniospinal radiotherapy: an underrecognised mixed endocrine toxicity"],"prefix":"10.1530","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0874-4345","authenticated-orcid":true,"given":"Katrien","family":"Slabbynck","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Vitaz, Sint-Niklaas, Belgium 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stijn","family":"Roels","sequence":"additional","affiliation":[{"name":"Department of Radiology, Vitaz, Sint-Niklaas, Belgium 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrien","family":"Erven","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Ziekenhuis Aan de Stroom (ZAS) Augustinus, Antwerp, Belgium 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Els","family":"Everaert","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Vitaz, Sint-Niklaas, Belgium 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Coremans","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Vitaz, Sint-Niklaas, Belgium 1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2026081809183687500_bib1","doi-asserted-by":"crossref","first-page":"e715","DOI":"10.1016\/S1470-2045(19)30669-2","article-title":"Eano-euracan clinical practice guideline for diagnosis, treatment, and follow-up of post-pubertal and adult patients with medulloblastoma","volume":"20","author":"Franceschi","year":"2019","journal-title":"Lancet Oncol"},{"key":"2026081809183687500_bib2","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1210\/er.2018-00092","article-title":"Long-term endocrine and metabolic consequences of cancer treatment: a systematic review","volume":"40","author":"Gebauer","year":"2019","journal-title":"Endocr Rev"},{"key":"2026081809183687500_bib3","doi-asserted-by":"crossref","DOI":"10.1016\/j.radonc.2024.110268","article-title":"Predictive factors for radiation-induced pituitary damage in pediatric patients with brain tumors","volume":"196","author":"Gorenstein","year":"2024","journal-title":"Radiother Oncol"},{"key":"2026081809183687500_bib4","article-title":"Role of magnetic resonance imaging in the evaluation of age- and gender-related changes in the dimensions of the pituitary gland in the Indian population","volume":"16","author":"Shajil","year":"2024","journal-title":"Cureus"},{"key":"2026081809183687500_bib5","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/cen.15216","article-title":"Systematic review and meta-analysis on the prevalence of radiotherapy-induced hypopituitarism in adults with primary non-pituitary brain tumours","volume":"102","author":"Donald","year":"2025","journal-title":"Clin Endocrinol"},{"key":"2026081809183687500_bib6","volume-title":"Endotext","author":"Pekic","year":"2000"},{"key":"2026081809183687500_bib7","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s11060-016-2306-7","article-title":"Long-term safety of growth hormone replacement therapy after childhood medulloblastoma and pnet: it is time to set aside old concerns","volume":"131","author":"Indini","year":"2017","journal-title":"J Neuro Oncol"},{"key":"2026081809183687500_bib8","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1016\/S0959-8049(98)00212-3","article-title":"Long-term neuro-endocrine sequelae after treatment for childhood medulloblastoma","volume":"34","author":"Heikens","year":"1998","journal-title":"Eur J Cancer"},{"key":"2026081809183687500_bib9","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3390\/diagnostics10030142","article-title":"Post-treatment thyroid diseases in children with brain tumors: a single-center experience at \u201cProf. Dr Ion chiricut\u0103\u201d institute of oncology, cluj-napoca","volume":"10","author":"Cosnarovici","year":"2020","journal-title":"Diagnostics"},{"key":"2026081809183687500_bib10","first-page":"4472","article-title":"Diagnosis of hidden central hypothyroidism in survivors of childhood cancer","volume":"84","author":"Rose","year":"1999","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2026\/2\/EDM-25-0143.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2026\/2\/EDM-25-0143.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article-pdf\/doi\/10.1530\/EDM-25-0143\/519870\/edm-25-0143.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article-pdf\/doi\/10.1530\/EDM-25-0143\/519870\/edm-25-0143.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T13:18:45Z","timestamp":1787059125000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/edm\/article\/2026\/2\/EDM250143\/77564\/Recognising-pituitary-and-thyroid-dysfunction"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1530\/edm-25-0143","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"EDM250143"}}