Growth and Hormonal Status of Children Treated for Brain Tumours

Shalet, Stephen M

doi:10.1159/000120064

Cited by 11 publications

(8 citation statements)

References 16 publications

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“…Exposure of the immature brain to ionizing radiation is not without its own risks. Previous studies have demonstrated altera tions in standard psychometric tests, hypothalamic in sufficiency and stunted growth after brain irradiation in children [Bamford et al, 1976;Shalet, 1982;Kun et al, 1983]. Clinical signs and symptoms of 'tumor progres sion' may be due in part to complications of RT and not to actual tumor growth [Mechanick et al, 1986].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Diencephalic Gliomas – A Review of 18 Cases

Jp²

1987

Pediatr Neurosurg

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Eighteen cases of biopsy-proven pediatric diencephalic gliomas are reviewed in terms of clinical presentation, radiographic features and pathological findings. Treatment included radiation therapy (RT) in 14, chemotherapy in 4 and conservative management in 3. Actuarial survival and quality of life are analyzed. We conclude that: (1) thalamic involvment portends a poor prognosis both in terms of histology and survival, (2) beneficial effects of RT are difficult to demonstrate and (3) therapy for pediatric diencephalic gliomas should be individualized and long-term spontaneous remissions may occur.

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Section: Discussionmentioning

confidence: 99%

Pediatric Diencephalic Gliomas – A Review of 18 Cases

Jp²

1987

Pediatr Neurosurg

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“…<14 milliunits/litre) to the arginine-insulin test despite a retarded growth rate. This has previously been shown (6,7) and makes this test of limited value as the sole predictor of GH deficiency. Therefore, 24-hour GH secretion was used for evaluation of G H dysfunction.…”

Section: Methods and Resultsmentioning

confidence: 89%

Growth Hormone Secretion and Response to Growth Hormone Therapy after Treatment for Brain Tumour

et al. 1988

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Lannering, B., Marky, I., Mellander, L. and Albertsson-Wikland, K. (Departments of Paediatrics I, I1 and Physiology, Gothenburg University, Gothenburg, Sweden). Growth hormone secretion and response to growth hormone after treatment for brain tumour. Acta Paediatr Scand [Suppl] 343:146, 1988. Children irradiated for brain tumours constitute an increasing group of patients who will require GH therapy. High-dose cranial irradiation is necessary for cure, but inevitably causes GH deficiency within a few years. In 19 patients investigated between 2 and 9 years after irradiation, the spontaneous 24-hour GH secretion was markedly reduced. The secretory pattern indicated loss of regulating hypothalamic hormones. After exogenous GHRH was administered, the pituitary was able to respond with a prompt GH release, showing that pituitary function was unaffected. Ten prepubertal children growing at 3.8 1 0.3 cm/year were treated with GH, 0.1 IU/kg/day S.C. Their growth rate increased to 8.2 f 0.4 cm in the first year. An increased growth rate was also maintained in the second year. Key words: Cranial irradiation, brain tumour, GH therapy, 24-hour GH profiles.Brain tumours are the most common solid tumours in childhood with an incidence of 3/100,000 children. About 70% of the tumours require irradiation for cure.Postoperative radiotherapy has so far been the single major advance in the treatment of malignant brain tumours (1). It has enabled a 50% 5-year disease-free survival for medulloblastomas ( 2 ) . Radiotherapy is given with a high irradiation dose (55 Gy) to the . t m o u r site and also to the whole brain (3&35 Gy) to prevent meningeal spread -the hypothilamic-pituitary axis thus inevitably receives irradiation. It is hoped that there will be more children surviving malignant brain turnours without severe sequelae in the future (3). Improved imaging methods, better operative techniques and new treatment protocols will contribute to this (4, 5). GH dysfunction, however, will continye to be a problem that has to be dealt with in an optimal way. In this study, data are presented to illustrate what the authors find to be the optimal way to diagnose and treat radiation-induced G H deficiency. PATIENTSThe study included 19 children who were between 1 and 16.9 years old at the time of radiotherapy for a brain tumour (n=16) or a cranial turnour (n=3). High-dose radiotherapy (>40 Gy) was given between 1970 and 1982 to the hypothalamic-pituitary region. The clinical data of the patients are listed in Table 1. The time from radiotherapy to G H investigation was at least 2 years, with a mean of 4 years. By then the patients were between 5 and 23 years old. About half of the patients had received chemotherapy for 1 year postoperatively.Control group A consisted of 20 children with constitutional short stature, growing below -2 SD, aged 6-14 years. Control group B comprised 24 healthy children growing between -2 SD and + 2 SD, aged 8-15 years. METHODS AND RESULTSGrowth deviation. Those children who were prepubertal at diagnosis an...

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“…Working on the premise that the initial lesion was a high-grade astrocytoma, the slowly progressive course may be more compatible with radia tion necrosis. The clinical impression at the time was dysfunction of the hypophysis-hypothalamic axis con sequent to radiation injury [12]. It is worth noting that in a series of 34 children with brain tumors and subsequent hypopituitarism, the incidence of tumor recurrence was not greater in those who received growth hormone ther apy (8 of 24), compared to those who did not (3 of 10) [13]Three years after diagnosis the radionuclide scan showed increased tracer deposition in the midline.…”

Section: Clinical Historymentioning

confidence: 94%