Pituitary dysfunction in childhood after [¹⁷⁷Lu]Lu-DOTATATE therapy

OBJECTIVES: Treatment for neuroblastoma with chemotherapy and [ 131I]MIBG can induce endocrine adverse effects, including thyroid disorders, gonadal insufficiency or short stature. Neuroblastoma can also be targeted at the somatostatin receptor, using [ 177 Lu]Lu-DOTATATE peptide receptor radionuclide therapy. Thus far no endocrine effects have been reported after [ 177 Lu]Lu-DOTATATE treatment in children.

CASE PRESENTATION: We report a first case of pituitary dysfunction, reflected as growth hormone deficiency and central hypothyroidism, following treatment with [ 177 Lu]Lu-DOTATATE for refractory neuroblastoma.

CONCLUSIONS: We hypothesize that the GH and TSH deficiency in this case are caused by pituitary damage through binding of [ 177 Lu]Lu-DOTATATE to the somatostatin receptors in the pituitary gland. If [ 177 Lu]Lu-DOTATATE in the future becomes a more upfront treatment we strongly underline screening on pituitary dysfunction after exposure to [ 177 Lu]Lu-DOTATATE in childhood.