Laura van Iersel1,2, Hanneke M van Santen2, Brian Potter3, Zhenghong Li4, Heather M Conklin3, Hui Zhang5, Wassim Chemaitilly1,4, Thomas E Merchant6. 1. Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee. 2. Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht, the Netherlands. 3. Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee. 4. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee. 5. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee. 6. Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract
BACKGROUND: To determine the impact of hypothalamic-pituitary (HP) disorders on health outcomes in children and adolescents who received conformal radiation therapy (RT) for central nervous system tumors. PROCEDURE: Cohort study including 355 patients (age ≤25 years at diagnosis) treated with high-dose (50.4-59.4 Gy) RT using photons for low-grade glioma or ependymoma. Patients (median age, 6.4 years at RT) received systematic endocrine follow-up (median duration, 10.1 years; range, 0.1-19.6). Associations between HP disorders and adverse health outcomes were determined by multivariable analysis. RESULTS: Prevalence was 37.2% for growth hormone deficiency (GHD), 17.7% for gonadotropin deficiency (LH/FSHD), 14.9% for thyroid-stimulating hormone deficiency (TSHD), 10.3% for adrenocorticotropic hormone deficiency (ACTHD), and 12.6% for central precocious puberty (CPP). Hypothalamus mean dose ≥ 36 Gy was associated with higher odds of any deficiency. GHD was associated with short stature (OR 2.77; 95% CI 1.34-5.70), low bone mineral density (OR 3.47; 95% CI 1.16-10.40), and TSHD with dyslipidemia (OR 5.54; 95% CI 1.66-18.52). Patients with ACTHD and CPP had lower intelligence quotient scores, and memory scores were impaired in patients with GHD (P = 0.02). Treatment of GHD was not associated with increased risk for tumor recurrence, secondary tumors, or mortality. CONCLUSIONS: HP disorders occur frequently in patients receiving high-dose RT and are related to physical and neurocognitive well-being. Future studies are needed to assess whether further optimization of endocrine management yields better health outcomes.
BACKGROUND: To determine the impact of hypothalamic-pituitary (HP) disorders on health outcomes in children and adolescents who received conformal radiation therapy (RT) for central nervous system tumors. PROCEDURE: Cohort study including 355 patients (age ≤25 years at diagnosis) treated with high-dose (50.4-59.4 Gy) RT using photons for low-grade glioma or ependymoma. Patients (median age, 6.4 years at RT) received systematic endocrine follow-up (median duration, 10.1 years; range, 0.1-19.6). Associations between HP disorders and adverse health outcomes were determined by multivariable analysis. RESULTS: Prevalence was 37.2% for growth hormone deficiency (GHD), 17.7% for gonadotropin deficiency (LH/FSHD), 14.9% for thyroid-stimulating hormone deficiency (TSHD), 10.3% for adrenocorticotropic hormone deficiency (ACTHD), and 12.6% for central precocious puberty (CPP). Hypothalamus mean dose ≥ 36 Gy was associated with higher odds of any deficiency. GHD was associated with short stature (OR 2.77; 95% CI 1.34-5.70), low bone mineral density (OR 3.47; 95% CI 1.16-10.40), and TSHD with dyslipidemia (OR 5.54; 95% CI 1.66-18.52). Patients with ACTHD and CPP had lower intelligence quotient scores, and memory scores were impaired in patients with GHD (P = 0.02). Treatment of GHD was not associated with increased risk for tumor recurrence, secondary tumors, or mortality. CONCLUSIONS:HP disorders occur frequently in patients receiving high-dose RT and are related to physical and neurocognitive well-being. Future studies are needed to assess whether further optimization of endocrine management yields better health outcomes.
Authors: Sarah Metzger; Annette Weiser; Nicolas U Gerber; Maria Otth; Katrin Scheinemann; Niklaus Krayenbühl; Michael A Grotzer; Ana S Guerreiro Stucklin Journal: J Neurooncol Date: 2022-02-11 Impact factor: 4.506
Authors: Jenneke E van Atteveld; Renée L Mulder; Marry M van den Heuvel-Eibrink; Melissa M Hudson; Leontien C M Kremer; Roderick Skinner; W Hamish Wallace; Louis S Constine; Claire E Higham; Sue C Kaste; Riitta Niinimäki; Sogol Mostoufi-Moab; Nathalie Alos; Danilo Fintini; Kimberly J Templeton; Leanne M Ward; Eva Frey; Roberto Franceschi; Vesna Pavasovic; Seth E Karol; Nadia L Amin; Lynda M Vrooman; Arja Harila-Saari; Charlotte Demoor-Goldschmidt; Robert D Murray; Edit Bardi; Maarten H Lequin; Maria Felicia Faienza; Olga Zaikova; Claire Berger; Stefano Mora; Kirsten K Ness; Sebastian J C M M Neggers; Saskia M F Pluijm; Jill H Simmons; Natascia Di Iorgi Journal: Lancet Diabetes Endocrinol Date: 2021-07-30 Impact factor: 44.867