Long‐term effects of treatment on endocrine function in children with brain tumors

Abstract

Fourteen children with brain tumors received endocrine evaluations at least one year following completion of cranial irradiation. Treatment consisted of operation (13 patients), craniospinal irradiation (6), whole brain irradiation (5), posterior fossa irradiation (3), and chemotherapy (10). Endocrine evaluation included bone age roentgenography and measurement of growth hormone (using sequential arginine and insulin stimulation), thyroxine, thyroid-stimulating hormone, plasma cortisol, testosterone, prolactin, and urinary follicle-stimulating hormone and luteinizing hormone. Ten of 12 children (83%) had abnormal responses to both tests of growth hormone stimulation. All growth hormone-deficient patients treated prior to puberty and tested at least 2 years following completion of cranial irradiation had decelerated linear growth. Results of thyroid function tests were abnormal in 4 patients: 2 patients had evidence of primary hypothyroidism, and 2 showed secondary or tertiary hypothyroidism. Two patients had inadequate cortisol responses to insulin hypoglycemia. Urinary follicle-stimulating hormone and luteinizing hormone, serum prolactin, and serum testosterone levels were appropriate for age in all patients.

Growth and Pituitary Function in Children Treated for Brain Tumours or Acute Lymphoblastic Leukaemia

“…Pro spective studies revealed that hypothalamic-pituitary function is normal immediately after surgery and before radiotherapy [5,6], The occurrence of GH deficiency as the earliest and often the only endocrine abnormality in children, who have undergone cranial irradiation, sug gests that this axis is the most sensitive to the deleterious effects of irradiation [7], There are no detailed studies of the sequence of pituitary hormone deficit following irra diation in childhood. However, our data [8] in adults irradiated (total dose 3,750-4,250 cGy) for pituitary tumours confirm this Finding with a 100% incidence of GH deficiency at 5 years ( fig.…”

Malignant Supratentorial Gliomas in Childhood

“…As the dose of radiation increases, both hypotha lamic and pituitary control of growth hormone regula tion may become affected, as reflected by abnormal in sulin and arginine stimulation tests [60]. Additionally, in children treated before puberty, linear growth will de celerate [61 ]. One prospective study has shown that up to 86% of children tested had abnormalities on growth hormone testing by 1 year [62].…”

Population Pharmacokinetics of Oral Topotecan in Infants and Very Young Children with Brain Tumors Demonstrates a Role of ABCG2 rs4148157 on the Absorption Rate Constant

“…However, infants and very young children less than 3 years old with primary central nervous system tumors have a poor prognosis due to the increased likelihood of disseminated disease at diagnosis and the morbidity of whole brain irradiation, among other factors (Duffner et al, 1983;Gajjar et al, 1994;Walter et al, 1999;Mulhern et al, 2004;Laughton et al, 2008). Little is known about the disposition of many anticancer drugs in infants and young children, which often leads to increased risk of morbidity, poor tumor control, and increased risk of late effects.…”