Repnnted from the Journal of the Amencan Medical As

August 3, 1984, Volume 252
Copyright 1984, American Medical Association

40105 1




The Medical Research Center
Brookhaven National Lahoratory
Upton, L. L, New York

cotpen 84/72 — 2205

Pituitary Tumors

Following Fallout Radiation Exposure
Witllam H. Adams, MD; James A. Harper, MD; Roger S. Rittmaster, MD; Roger C. Grimson, PhD

® Two pituitary tumors were diagnosed in a small population of Marshallese accidentally exposed to radioactive fallout in 1954.
(JAMA 1984;252:664-666)
IN 1954, the populations of two atolls
nae.’ We now report the newest
in the Marshall Islands were accidenendocrinologic finding in the exposed
tally exposed to radioactive fallout
population, that being two cases of
from a test detonation of a thermonupituitary tumor, and address the posclear bomb. The acute and delayed
sible relation of the tumors to radiaeffects of their radiation exposure
tion exposure and thyroid disease.
have been the subject of numerous
Report of Cases
publications (an extensive listing can
Rongelap woman was 20
be found in reference 1). In brief, the
average total-body. external gamma - years old when exposed to radioactive
fallout. In addition to receiving an estiradiation received on the islands of
mated total-body absorbed dose of 190 rad
Rongelap (64 persons), Ailingnae (18
of external gamma radiation, an estimated
persons), and Utirik (157 persons) has
1,100 rad was absorbed by her thyroid

been calculated to be 190, 110, and 11

rad, respectively.” All survived the
initial effects of hematopoietic suppression and skin burns. Internalization of radionuclides also occurred,
including radioactive iodines. Longterm follow-up has revealed, as a
consequence, a high incidence of thyroid neoplasia and hypofunction, especially among those persons who
had been on Rongelap and AilingFrom the Medical Research Center, Brookhaven
National Laboratory, Upton, NY (Drs Adams, Harper,
and Rittmaster); and the Department of Community
and Preventive Medicine, Health Sciences Center,
State University of New York at Stony Brook (Dr
Reprint requests to Medical Department, Brookhaven National Laboratory, Upton, NY 11973 (Dr


JAMA, Aug 3,

gland due to intake of radioactive iodines
and telluriums.’ Thyroxin supplementation was begun at age 32 years following
the discovery of thyroid nodules in other
exposed Rongelapese. Three years later,
however, a total thyroidectomy was performedfor papillary carcinoma. Roentgenograms of the skull, taken as part of a
routine follow-up examination seven years
later (1976), unexpectedly revealed erosion
of the anterior floor of the sella turcica
and a mass extending into the sphenoid
sinus (Fig 1). She had no symptoms suggesting a pituitary lesion, and visualfield
examination results were normal. She had
borne 14 children by age 35 years and
continued to have normal menstrual
cycles. Ora] contraceptives were never
used. Evaluation at the Clinical Center of
the National Institutes of Health (under

1984—Vol 252, No. 5

the care of Jacob Robbins, MD) confirmed
the roentgenographic findings, and computed tomography (CT) revealed no supra-

sellar extension of the tumor. Thyroid
function tests performed in the years prior
to diagnosis are presented in Table 1.
Endocrinologic studies indicated normal
levels of serum follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, morning cortisol, total thyroxine,
free thyroxine, and triiodothyronine. The
diagnosis of a nonfunctioning pituitary
adenoma was made, and therapeutic irra_diation was administered, During the sixyear follow-up, menstrual function and
results of visual field examinations and
endocrinologic studies have remained normal. (Data from this patient are also
presented in reference 1.)
CasE 2.—A 29-year-old woman was
younger than 1 year at the time of her
radiation exposure on Utirik. In contrast
to most of the other exposed inhabitants,
she left the fallout area within 24 hoursof
its onset and never returned to the atoll.
External whole-body and thyroid radiation absorbed doses were estimated at 11
and 660 rad, respectively.’ Menarche was
at age 13 years, but within a few years she
became amenorrheic. Although subsequently married, she had no pregnancies.
Oral contraceptives were not used. Results
of annual physical examinations by Brookhaven National Laboratory physicians
were routinely normal, although the uter-

us was thought to be somewhat small. A
history of galactorrhea was obtained in
1977. Her thyroid-stimulating hormone
levels at ages 18, 24, and 25 years were
normal (Table 1). Evaluation for secondary amenorrhea at age 26 years revealed a

’ serum prolactin level of 480 ng/mL. She
was subsequently admitted
Center of the National
Health (under the care
Loriaux, MD), where CT

to the Clinical
Institutes of
of D. Lynn
of the sella

Pituitary Tumors— Adams etal

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