The Effect of Varying Doses of Cerebral Irradiation on Growth Hormone Production in Childhood

Shalet, Stephen M; Beardwell, Colin G; Pearson, D; Jones, Patricia B.

doi:10.1111/j.1365-2265.1976.tb01955.x

Cited by 190 publications

(72 citation statements)

References 12 publications

(13 reference statements)

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“…The frequency of G H deficiency was reported to vary according to the initial disease and the effective biologic dose of radiation reaching the hypothalamopituitary region. An inverse correlation was found between that dose and the plasma GH response to pharmacologic stimulation (3,13). We have found that 56% of a group of children given 2400 cGrays (Gy or rad) as prophylactic irradiation for ALL had G H deficiency, with a GH peak response to the arginine-insulin stimulation test (AIST) less than 8 ng/ml (Table 1).…”

Section: Growth Hormone Deficiencymentioning

confidence: 91%

Growth and Endocrine Disorders Secondary to Cranial Irradiation

1989

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Section: Growth Hormone Deficiencymentioning

confidence: 91%

Growth and Endocrine Disorders Secondary to Cranial Irradiation

1989

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“…There is a strong correlation between the total radiation dose and the development of pituitary hormone deficits (Shalet et al 1976a, Duffner et al 1985, Littley et al 1989b, Clayton & Shalet 1991b, Constine et al 1993. Thus, after lower radiation doses, as used in the treatment of acute lymphoblastic leukaemia (ALL) or brain tumours (18-50 Gy), isolated growth hormone deficiency (GHD) occurs, while higher doses (> 60 Gy) may produce panhypopituitarism.…”

Section: Role Of Radiationmentioning

confidence: 99%

The impact of cancer therapy on the endocrine system in survivors of childhood brain tumours

Gleeson¹,

Shalet²

2004

Endocr Relat Cancer

144

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Survival rates are improving following cancer therapy for childhood brain tumours. There is therefore a growing cohort of survivors at risk of late effects of cancer therapy. Endocrine problems are very common in these patients. The recognition and prompt management of these are essential to prevent further morbidity and impairment of quality of life.Cranial radiation can damage hypothalamic-pituitary function, most frequently affecting GH status; however, higher radiation doses may cause more widespread hypothalamic-pituitary damage. Early puberty secondary to cranial irradiation is now being managed with gonadotrophin-releasing hormone analogues to improve final height. Prompt diagnosis and management of GH deficiency may improve final height outcome; continued GH therapy beyond final height aids the achievement of adult body composition (lean body mass and bone mass) and GH therapy in adulthood improves quality of life. Both cranial irradiation alone and with spinal irradiation can result in radiation damage to the thyroid resulting in hypothyroidism and thyroid nodules, a high proportion of which are malignant. Gonadal damage secondary to spinal irradiation and adjuvant chemotherapy may have long-term consequences including infertility.

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“…Stem-cell transplantation regimens using total-body irradiation yield a 25% incidence at 5 to 10 years for 8 to 12 Gy and a 50% incidence at 10 years for 14.4 Gy. 8 Cranial irradiation regimens using doses of more than 24 Gy yield a 66% incidence, 9,10 and regimens using doses of more than 30 Gy lead to incidences as high as 80% by 10 years. 11 In one series of optic pathway tumors, doses in excess of 45 Gy resulted in a 100% incidence of GHD within 2 years.…”

Section: Introductionmentioning

confidence: 99%

Growth Hormone Secretion After Conformal Radiation Therapy in Pediatric Patients With Localized Brain Tumors

Merchant

Rose²,

Bosley³

et al. 2011

JCO

139

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A B S T R A C T PurposeGrowth hormone deficiency (GHD) after radiation therapy negatively affects growth and development and quality of life in children with brain tumors. Between 1997 and 2008, 192 pediatric patients with localized primary brain tumors (ependymoma, n ϭ 88; low-grade glioma, n ϭ 51; craniopharyngioma, n ϭ 28; high-grade glioma, n ϭ 23; and other tumor types, n ϭ 2) underwent provocative testing of GH secretion by using the secretogogues arginine and L-dopa before and after (6, 12, 36, and 60 months) conformal radiation therapy (CRT). A total of 664 arginine/L-dopa test procedures were performed. Patients and Materials ResultsBaseline testing revealed preirradiation GHD in 22.9% of tested patients. On the basis of data from 118 patients, peak GH was modeled as an exponential function of time after CRT and mean radiation dose to the hypothalamus. The average patient was predicted to develop GHD with the following combinations of the time after CRT and mean dose to the hypothalamus: 12 months and more than 60 Gy; 36 months and 25 to 30 Gy; and 60 months and 15 to 20 Gy. A cumulative dose of 16.1 Gy to the hypothalamus would be considered the mean radiation dose required to achieve a 50% risk of GHD at 5 years (TD 50/5 ). ConclusionGH secretion after CRT can be predicted on the basis of dose and time after irradiation in pediatric patients with localized brain tumors. These findings provide an objective radiation dose constraint for the hypothalamus.

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The Effect of Varying Doses of Cerebral Irradiation on Growth Hormone Production in Childhood

Cited by 190 publications

References 12 publications

Growth and Endocrine Disorders Secondary to Cranial Irradiation

Growth and Endocrine Disorders Secondary to Cranial Irradiation

The impact of cancer therapy on the endocrine system in survivors of childhood brain tumours

Growth Hormone Secretion After Conformal Radiation Therapy in Pediatric Patients With Localized Brain Tumors

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