Hypothalamic pituitary dysfunction amongst nasopharyngeal cancer survivors.

PURPOSE: Radiation fields for nasopharyngeal cancer (NPC) include the base of skull, which places the hypothalamus and pituitary at risk of damage. We aimed to establish the prevalence, pattern and severity of hypothalamic pituitary (HP) dysfunction amongst NPC survivors. METHODS: We studied 50 patients (31 males) with mean age 57 ± 12.2 years who had treatment for NPC between 3 and 21 years (median 8 years) without pre-existing HP disorder from other causes. All patients had a baseline cortisol, fT4, TSH, LH, FSH, oestradiol/testosterone, prolactin and renal function. All patients underwent dynamic testing with insulin tolerance test to assess the somatotroph and corticotroph axes. Baseline blood measurements were used to assess thyrotroph, gonadotroph and lactotroph function. RESULTS: Hypopituitarism was present in 82% of patients, 30% single axis, 28% two axes, 18% three axes and 6% four axes deficiencies. Somatotroph deficiency was most common (78%) while corticotroph, gonadotroph and thyrotroph deficiencies were noted in 40% (4 complete/16 partial), 22 and 4% of the patients respectively. Hyperprolactinaemia was present in 30% of patients. The development of HP dysfunction was significantly associated with the time elapsed from irradiation, OR 2.5 (1.2, 5.3), p = 0.02, for every 2 years post treatment. The use of concurrent chemo-irradiation (CCRT) compared to those who had radiotherapy alone was also significantly associated with HP dysfunction, OR 14.5 (2.4, 87.7), p < 0.01. CONCLUSION: Despite low awareness and detection rates, HP dysfunction post-NPC irradiation is common. Use of CCRT may augment time related pituitary damage. As these endocrinopathies result in significant morbidity and mortality we recommend periodic assessment of pituitary function amongst NPC survivors.

Dental prosthesis ingested and impacted in the esophagus and orolaryngopharynx.

OBJECTIVE: Impacted foreign bodies in the trachea and esophagus are common. In the esophagus, these are usually bones, while for the trachea, it is commonly some form of seed or nut. The incidence of impacted dental prostheses is not highlighted in the literature. They usually have a definite history of ingestion, frequently during trauma, seizures, or sleep. Prompt management in a safe and effective manner is required if significant morbidity, and even mortality, is to be avoided. METHOD: The records of all patients who presented to the University Hospital in Kuala Lumpur with a definite history of foreign-body ingestion in the form of a dental prosthesis were reviewed, and their respective radiographs reassessed. RESULTS: There were 21 patients with impacted dental prostheses from a total of 200 patients who had impacted foreign bodies (11.5%). Indirect laryngoscopy detected five of these dentures, and in only seven were the dentures seen on plain radiography (33%)-all of which had metal wires attached. Of the 21 patients, 16 had the foreign bodies removed endoscopically; 2 could not be removed and were allowed to pass through the gastrointestinal tract under close monitoring; and 3 whose dental prostheses were not detected and who subsequently passed the foreign bodies. CONCLUSIONS: Impacted dental prostheses appear to constitute a significant proportion of impacted foreign bodies in the orolaryngopharynx. The majority are radiolucent. In the presence of positive history or/and symptoms, endoscopic examination and removal is suggested if possible to reduce morbidity. No serious complications have been seen.