Prevalence and Risk Factors for Endocrine Disorders in Childhood Brain Tumors From a Single Tertiary Center in Malaysia

Abstract

Patients with childhood brain tumors are at risk of endocrine disorders. The prevalence of endocrine disorders varies across the world but is unknown in Malaysia. This study’s objectives were to determine the prevalence of endocrine disorders among children with brain tumors in Malaysia and to identify endocrinopathy-associated risk factors. We retrospectively reviewed the clinical data of pediatric patients with brain tumors diagnosed and treated at the University Malaya Medical Center from 1 January 2001 to 31 December 2015, with a follow-up period until the age of 18 years old or at least 3 years from the initial diagnosis. A total of 106 patients were included; 71 patients (66%) were screened for endocrine disorders, and 61% of these had endocrine disorders at a median follow-up of 4 years. Hypothyroidism, short stature, and adrenocortical insufficiency were present in one-third of the patients, followed by central diabetes insipidus (21%), growth hormone deficiency (10%), delayed puberty (9%), and precocious puberty (4%). Radiation therapy and surgical intervention were risk factors for endocrine disorders, but hydrocephalus, supratentorial tumors, and malignant tumors were not. Most endocrinopathies developed within the first 2 years of brain tumor diagnosis. Therefore, standard endocrine-monitoring guidelines aiming for early diagnosis and therapy are essential.

Endocrine Disorders in Childhood Brain Tumour Survivors: A Single-Centre Study

“…The prevalence of endocrine disorders among childhood brain tumour survivors (CBTS) in our centre was 62% which was almost similar to a local study conducted in Klang valley by Ng et al, 61%. 8 Our prevalence was higher compared to other studies done in South Korea (37.1%), Netherlands (22.1%) and United States (49%). 2 , 9 , 10 Studies by Clement et al, in the Netherlands excluded patients with craniopharyngioma or a pituitary gland tumour while our study not only included all childhood brain tumour survivors, but also all types of endocrine complications such as obesity, growth, pubertal disorders and water/salt disturbances.…”

“…Ng et al, reported ACTH deficiency was the most prevalent (37%) followed by hypothyroidism (35%) and CDI (21%). 8 In other parts of the world, the commonest hormonal deficiency was GHD that ranged from 12 to 58% and this pattern was seen more consistently compared to other hormonal deficiencies, [17][18][19] Short stature (46%) was the most common clinical presentation seen in our centre and the causes could be multifactorial, such as specific hormonal deficiency secondary to GHD, hypothyroidism, ACTH deficiency, poor nutrition, familial short stature or constitutional delay in growth and puberty (CDGP). 19 This finding was also reported by Gurney et al, and Pasqualini et al 20,21 Despite it being the most common manifestation, not all the CBTS were referred to endocrine unit for screening of the specific hormonal deficiency which might be due to poor awareness among the primary doctors.…”

“…Ng et al, reported ACTH deficiency was the most prevalent (37%) followed by hypothyroidism (35%) and CDI (21%). 8 In other parts of the world, the commonest hormonal deficiency was GHD that ranged from 12 to 58% and this pattern was seen more consistently compared to other hormonal deficiencies, 17 - 19 …”

“…The prevalence of pubertal delay varies between studies with a range of 4 to 11%. 8 , 11 It is most often underrepresented due to missing pubertal assessment or short duration of follow up because the median age of diagnosis was at prepubertal age. Alkylating agents cause gonadal toxicity and results in a hypergonadotropic form of hypogonadism or primary hypogonadism.…”