FaAl7g INO S3L/SH Repnnted from the Journal of the Amencan Medical As August 3, 1984, Volume 252 Copyright 1984, American Medical Association 40105 1 REPOSITORY BNL KECORDS cottection LZARSHALL ISLANDS BOXNo. MEDICAL DEPT PUBLICATIONS 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) 4 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 Case 1.—A 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 Grimson). Reprint requests to Medical Department, Brookhaven National Laboratory, Upton, NY 11973 (Dr Adams) 664 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