Magnetic Resonance Imaging of the Pituitary Area in Children Treated for Acute Lymphoblastic Leukemia With Low-Dose (18-Gy) Cranial Irradiation

Cicognani, Alessandro; Cacciari, E; Carlà, G; Rosito, P; Cau, Marco; Mancini, Antonia; Zucchini, Stefano; Vecchi, Vico; Pirazzoli, Piero; Paolucci, G

doi:10.1001/archpedi.1992.02160230101028

Cited by 21 publications

(14 citation statements)

References 27 publications

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“…The frequency of low GH peaks in this study, the decreased pituitary height with a signi®cant correlation between pituitary height and GH peak and area in the arginine test, and mean GH concentration at night [4] all suggest that 18 Gy CI decreases GH secretion. This reduced GH secretion is probably not sucient to reduce the plasma IGF-I or IGFBP-3 values, but the normal values for age of these in spite of GH de®ciency may re¯ect the early secretion of sex steroids, as suggested by the signi®cantly lower values in the prepubertal compared to the pubertal patients.…”

Section: Discussionsupporting

confidence: 48%

Growth hormone secretion, puberty and adult height after cranial irradiation with 18 Gy for leukaemia

Melin

Adan

Leverger

et al. 1998

European Journal of Pediatrics

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In children irradiated for acute lymphoblastic leukaemia, GH deficiency is frequent after 18 Gy but its impact on adult height is smaller than after higher doses. We suggest that the indications for gonadotropin releasing hormone analogue therapy should be broad in patients with early or rapidly progressing puberty and those for GH therapy in those patients with a below average constitutional height before irradiation.

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Section: Discussionsupporting

confidence: 48%

Growth hormone secretion, puberty and adult height after cranial irradiation with 18 Gy for leukaemia

Melin

Adan

Leverger

et al. 1998

European Journal of Pediatrics

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“…It has recently been suggested that in irradiated patients the relatively small amount of GH could be sufficient for prepubertal but not for pubertal growth [5,8,15]. Impaired pubertal growth has been reported in girls treated for ALL by M6ell et al [15] and in both sexes by Uruena et al [25].…”

Section: Discussionmentioning

confidence: 99%

“…In our patients this phenomenon was evident in both dose regimens but it was significant only in girls treated with 2400 cGy. The higher decre-ment in final height of younger children may be related to a greater susceptibility of the hypothalamo-pituitary region to radiation damage as evidenced by a smaller pituitary dimension [5] and a more evident subnormal GH release [3] in children irradiated at a younger age.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal growth and final height in long-term survivors of childhood leukaemia

Cicognani¹,

Cacciari²,

Rosito³

et al. 1994

Eur J Pediatr

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Survival of children with acute lymphoblastic leukaemia (ALL) has increased considerably in recent years and data on the spontaneous growth and final height of these children are conflicting. Therefore, we analysed the longitudinal growth and final height in 52 survivors (33 females, 19 males) of childhood ALL. These children were diagnosed and treated in a single institution, all remained in first remission and were submitted to cranial irradiation with either 2400 or 1800 cGy. None of the patients received testicular or spinal irradiation. Median age at diagnosis was 4.2 (range 1.3-9.6) years in the first group (2400 cGy) and 3.9 (0.8-10.5) years in the second (1800 cGy). Standing height was measured at diagnosis, at the end of treatment (median 3.1 years after diagnosis), 6, 12, 24 months after the end of treatment, and finally at the completion of growth. In girls a significant decrease of mean height standard deviation score (SDS) during treatment and a catch up in growth after the end of therapy was followed by a second period of reduced growth. Mean final height SDS was significantly lower than the value at diagnosis in both groups of girls, but only in males treated with 2400 cGy. Mean overall loss in height SDS from diagnosis to final height was higher in females (-1.24) than in males (-0.40) (P = 0.009). Females < or = 4 years of age at diagnosis showed a higher loss in final height than females > 4 years.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…In the investigation by Cicognani et al [25], which differs from the others since the pituitary region of 28 children previously irradiated for acute lymphoblastic leukemia, was examined by MRI, and a positive correlation between GH secretion (arginine test peak and area and mean noc turnal concentration) and pituitary height was found. Fur thermore, the patients with pituitary height <4 mm pre sented a higher percentage of low response to tests.…”

Section: Relationships Between Morphology and Functionmentioning

confidence: 96%

“…Hypothalamic-Pituitary Disorders [24] and Cicognani et al [25], In the first study, in fact, the mostly hypoplastic glands were found in subjects with more severe GH deficiency, and the authors even stated that 'the diagnosis of permanent GH deficiency should be questioned when the pituitary height is normal for age'. In the investigation by Cicognani et al [25], which differs from the others since the pituitary region of 28 children previously irradiated for acute lymphoblastic leukemia, was examined by MRI, and a positive correlation between GH secretion (arginine test peak and area and mean noc turnal concentration) and pituitary height was found.…”

Section: Relationships Between Morphology and Functionmentioning

confidence: 99%

Role of Magnetic Resonance Imaging in Hypothalamic- Pituitary Disorders

et al. 1995

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Improvement of MRI diagnostic accuracy in the study of the hypothalamic-pituitary region provides precise anatomic details. In pituitary dwarfism, MRI reveals severe sella/pituitary gland and stalk hypoplasia with or without posterior pituitary ectopia, and empty sella, and this more frequently in patients with multiple pituitary hormone deficiency. Two main hypotheses have been proposed to explain these findings: traumatic stalk transection during breech delivery, and abnormal embryonic development of the pituitary gland. The association between neuroradiological findings and type/severity of endocrine alteration has not yet been clarified. In diabetes insipidus, MRI findings are normal picture, posterior lobe not visible, and thickened stalk (as expression of preclinical/initial histocytosis). Patients with central precocious puberty or hypogonadotropic hypogonadism rarely show morphologic abnormalities (hamartoma of the tuber cinereum, partially empty sella). So far, MRI permits one to identify morphologic pictures in diseases previously considered ‘idiopathic’.

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Magnetic Resonance Imaging of the Pituitary Area in Children Treated for Acute Lymphoblastic Leukemia With Low-Dose (18-Gy) Cranial Irradiation

Cited by 21 publications

References 27 publications

Growth hormone secretion, puberty and adult height after cranial irradiation with 18 Gy for leukaemia

Growth hormone secretion, puberty and adult height after cranial irradiation with 18 Gy for leukaemia

Longitudinal growth and final height in long-term survivors of childhood leukaemia

Role of Magnetic Resonance Imaging in Hypothalamic- Pituitary Disorders

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