Osteoporosis and Spondylolisthesis after Comprehensive Treatment for Brain Tumor: A Case Report.

Abstract

A 10-year-old boy who presented with hypopituitarism was diagnosed with supraseller germinoma based on the findings of brain magnetic resonance imaging (MRI). Dissemination of the tumor to the spinal cord was also evident. The patient was first treated with irradiation to both the brain and spinal cord, followed by chemotherapy with cisplatin (CDDP) and etoposide . Peripheral blood stem cell transplantation (PBSCT) with extensive chemotherapy was performed when he was 14 years old. During and after the treatment for the brain tumor, he was placed on hormone replacement with corticosteroid hormone, l-thyroxine, and 1-deamino-8-D-arginine-vasopressin (DDAVP). Growth hormone was also replaced after 2 years from PBSCT. The patient was noted to have gait disturbance, osteoporosis and spondylolisthesis of the lumbar vertebrae (L) at 18 years old. His mean bone mineral density (BMD) of the 2nd to 4th lumbar vertebrae was 0.59 g/m 2 . There was no evidence of recurrence of the tumor. It is possible that a high dose of local irradiation, long-term corticosteroid hormone replacement, and a hypogonadal state are related to the onset and progression of the skeletal abnormalities.