Wassim Chemaitilly1, Zhenghong Li2, Sujuan Huang2, Kirsten K Ness2, Karen L Clark2, Daniel M Green2, Nicole Barnes2, Gregory T Armstrong2, Matthew J Krasin2, Deo Kumar Srivastava2, Ching-Hon Pui2, Thomas E Merchant2, Larry E Kun2, Amar Gajjar2, Melissa M Hudson2, Leslie L Robison2, Charles A Sklar2. 1. Wassim Chemaitilly, Zhenghong Li, Sujuan Huang, Kirsten K. Ness, Karen L. Clark, Daniel M. Green, Nicole Barnes, Gregory T. Armstrong, Matthew J. Krasin, Deo Kumar Srivastava, Ching-Hon Pui, Thomas E. Merchant, Larry E. Kun, Amar Gajjar, Melissa M. Hudson, and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY. wassim.chemaitilly@stjude.org. 2. Wassim Chemaitilly, Zhenghong Li, Sujuan Huang, Kirsten K. Ness, Karen L. Clark, Daniel M. Green, Nicole Barnes, Gregory T. Armstrong, Matthew J. Krasin, Deo Kumar Srivastava, Ching-Hon Pui, Thomas E. Merchant, Larry E. Kun, Amar Gajjar, Melissa M. Hudson, and Leslie L. Robison, St Jude Children's Research Hospital, Memphis, TN; and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY.
Abstract
PURPOSE: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. PATIENTS AND METHODS: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. RESULTS: The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. CONCLUSION: Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.
PURPOSE: To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies. PATIENTS AND METHODS: Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness. RESULTS: The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness. CONCLUSION:Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.
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