BACKGROUND: Our aim was to evaluate endocrinological status 10-21 years after treatment for childhood acute lymphoblastic leukemia (ALL) with chemotherapy (C) and cranial irradiation (C + I) or only C, and to correlate the endocrine data with growth parameters. PROCEDURE: Of 30 patients (15 females and 15 males), 18 were treated with C + I and 12 were treated with C only. Height standard deviation score (HSDS) and body mass index standard deviation score (BMISDS) before treatment, at end of treatment, and at follow-up were calculated from height and weight registered from the charts. At follow-up examinations, provocative growth hormone (GH) tests (clonidine and insulin tolerance test) and an ACTH test were performed. Furthermore, blood samples for hormonal analysis, IGF-I, IGFBP-3, GHBP, and leptin were drawn. RESULTS: Eleven patients (9 treated with C + I and 2 treated with C) showed insufficient response to GH tests. Two patients had hypogonadism. HSDS and IGF-I were significantly lower and GHBP significantly higher in GH-deficient patients compared to the group with normal GH secretion at follow-up. BMISDS steadily increased from start of treatment until follow-up, independent of GH status at follow-up. BMISDS at follow-up was positively correlated with serum leptin (P < 0.001), and serum leptin was significantly higher in the cranial irradiated group as compared to the nonirradiated group. CONCLUSIONS: GH deficiency is frequently found at long-term follow-up in patients treated for childhood ALL. Other hormonal deficiencies are rare. HSDS at long-term follow-up is dependent on GH secretory status. Long-term endocrinological follow-up examinations in patients treated for childhood ALL are recommended, as hormonal replacement therapy may be indicated.
BACKGROUND: Our aim was to evaluate endocrinological status 10-21 years after treatment for childhood acute lymphoblastic leukemia (ALL) with chemotherapy (C) and cranial irradiation (C + I) or only C, and to correlate the endocrine data with growth parameters. PROCEDURE: Of 30 patients (15 females and 15 males), 18 were treated with C + I and 12 were treated with C only. Height standard deviation score (HSDS) and body mass index standard deviation score (BMISDS) before treatment, at end of treatment, and at follow-up were calculated from height and weight registered from the charts. At follow-up examinations, provocative growth hormone (GH) tests (clonidine and insulin tolerance test) and an ACTH test were performed. Furthermore, blood samples for hormonal analysis, IGF-I, IGFBP-3, GHBP, and leptin were drawn. RESULTS: Eleven patients (9 treated with C + I and 2 treated with C) showed insufficient response to GH tests. Two patients had hypogonadism. HSDS and IGF-I were significantly lower and GHBP significantly higher in GH-deficientpatients compared to the group with normal GH secretion at follow-up. BMISDS steadily increased from start of treatment until follow-up, independent of GH status at follow-up. BMISDS at follow-up was positively correlated with serum leptin (P < 0.001), and serum leptin was significantly higher in the cranial irradiated group as compared to the nonirradiated group. CONCLUSIONS:GH deficiency is frequently found at long-term follow-up in patients treated for childhood ALL. Other hormonal deficiencies are rare. HSDS at long-term follow-up is dependent on GH secretory status. Long-term endocrinological follow-up examinations in patients treated for childhood ALL are recommended, as hormonal replacement therapy may be indicated.
Authors: Eric J Chow; Debra L Friedman; Yutaka Yasui; John A Whitton; Marilyn Stovall; Leslie L Robison; Charles A Sklar Journal: J Pediatr Date: 2007-04 Impact factor: 4.406
Authors: Austin L Brown; Philip J Lupo; Heather E Danysh; Mehmet F Okcu; Michael E Scheurer; Kala Y Kamdar Journal: J Pediatr Hematol Oncol Date: 2016-08 Impact factor: 1.289
Authors: Laura van Iersel; Zhenghong Li; Deo Kumar Srivastava; Tara M Brinkman; Kari L Bjornard; Carmen L Wilson; Daniel M Green; Thomas E Merchant; Ching-Hon Pui; Rebecca M Howell; Susan A Smith; Gregory T Armstrong; Melissa M Hudson; Leslie L Robison; Kirsten K Ness; Amar Gajjar; Kevin R Krull; Charles A Sklar; Hanneke M van Santen; Wassim Chemaitilly Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958
Authors: Gregory T Armstrong; John A Whitton; Amar Gajjar; Larry E Kun; Eric J Chow; Marilyn Stovall; Wendy Leisenring; Leslie L Robison; Charles A Sklar Journal: Cancer Date: 2009-06-01 Impact factor: 6.860