Some people who were treated for cancer during childhood may develop hormone problems as a result of changes to a complex system of glands known as the endocrine system. These glands include the pituitary and adrenals.
What is Central Adrenal Insufficiency?
The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH). This hormone triggers the adrenal glands to make another hormone called cortisol. When the pituitary gland doesn’t make enough ACTH, the adrenal glands will not produce cortisol. Cortisol is important because it helps keep blood sugar levels normal and helps the body deal with physical stress, such as fever or injury.
Am I at Risk?
Cancer survivors who received radiation to the brain, especially at higher doses, have a greater risk for central adrenal insufficiency. So do survivors who had their pituitary gland removed.
What Are the Symptoms of Central Adrenal Insufficiency?
Under everyday circumstances you might have no symptoms or only mild symptoms, such as fatigue, weakness, poor appetite, or feeling dizzy. But symptoms can become severe if your body is stressed by fever, infection, surgery, or injury. Severe symptoms might include vomiting, diarrhea, low blood sugar, and dehydration.
Should I Be Checked for Central Adrenal Insufficiency?
All childhood cancer survivors should have a health check-up every year that includes measurement of your height and weight and assessment of your pubertal status, nutritional status, and overall well-being.
If you had radiation to the brain, or if you have symptoms that suggest your cortisol levels might be low, ask your doctor if you should have your cortisol levels checked, too.
Survivors who had their pituitary gland removed or radiation to the central part of the brain at a dose of 40 Gy or higher need their cortisol levels checked every year for at least 15 years.
If your cortisol level is not normal your doctor will likely refer you to a doctor who specializes in hormone problems (an endocrinologist).
What If I Have Central Adrenal Insufficiency?
Central adrenal insufficiency is treated with a medicine called hydrocortisone. It’s taken by mouth every day. The dose is increased when your body is stressed physically, such as by illness or surgery.
Also, be sure to wear a medical alert bracelet if you have central adrenal insufficiency. It will make emergency medical workers aware of your health needs should you have an accident or sudden illness.