The relationship between the growth hormone and insulin‐like growth factor axis in long‐term survivors of childhood brain tumours

Achermann, John C.; Hindmarsh, Peter C.; Brook, C. G. D.

doi:10.1046/j.1365-2265.1998.00585.x

Cited by 27 publications

(21 citation statements)

References 39 publications

(48 reference statements)

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“…Although previous reports suggested that chemotherapy potentiates the deleterious effect of radiation on pituitary function [37], we did not find an association between endocrine dysfunctions and chemotherapy treatment for childhood brain tumor, except for a nonsignificantly higher prevalence of GH deficiency. Whether adjuvant chemotherapy combined with radiation increases the risk of hypothyroidism compared with radiation alone remains controversial [20,23].…”

Section: Discussioncontrasting

confidence: 51%

Endocrine Outcome in Long-Term Survivors of Childhood Brain Tumors

Shalitin¹,

Gal²,

Goshen

et al. 2011

Horm Res Paediatr

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Aim: To evaluate the rates of endocrine abnormalities in survivors of childhood brain tumors and identify risk factors. Methods: The medical charts of patients were reviewed for background, disease-related and treatment-related data. Endocrine dysfunction was determined by clinical and laboratory evaluation. Results: The study group included 114 patients with a mean age of 15.57 ± 5.93 years. Mean age at brain tumor diagnosis was 7.07 ± 5.42 years, and mean follow-up was 12.8 ± 6.25 years. Fifty-seven patients (50%) had an endocrine abnormality. The occurrence of several endocrine abnormalities was significantly associated with cranial irradiation and age <16 years at tumor diagnosis. The presence of growth hormone deficiency (n = 40) was associated with cranial or spinal irradiation, younger age and prepubertal stage at tumor diagnosis; the presence of hypogonadotropic hypogonadism (n = 9) was associated with prepubertal stage at diagnosis, and hypothyroidism (n = 23) was associated with cranial irradiation. Hypocortisolism was diagnosed in 9 patients, short stature in 20 patients and obesity in 8 male patients. Patients with early puberty (n = 19) and an abnormal lipid profile (n = 15) were significantly younger at tumor diagnosis than patients without these disorders. Conclusions: Childhood brain tumor survivors are at increased risk of late endocrine effects, particularly those treated with cranial radiation and diagnosed at a younger age. The frequency of hormonal deficits increases with time, warranting lifelong surveillance.

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Section: Discussioncontrasting

confidence: 51%

Endocrine Outcome in Long-Term Survivors of Childhood Brain Tumors

Shalitin¹,

Gal²,

Goshen

et al. 2011

Horm Res Paediatr

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“…However, comparable to height SDS data, we found lower IGF1 levels than Dutch references in all childhood cancer survivors, except for non-irradiated survivors of Wilms tumour. Reduced IGF1 levels and shorter stature in childhood cancer survivors might partly be explained by treatment factors, as it is well known that irradiation at young age involving the whole brain, or any part of it, and TBI affects growth and IGF1 levels (25,26,27). However, even in the group of non-irradiated survivors, IGF1 levels were significantly lower than in the normal population in contrast to non-irradiated survivors of Wilms tumour, who had IGF1 levels comparable to the normal population and showed a trend to be higher Final height in Wilms tumour survivors than other non-irradiated survivors, which is a remarkable finding.…”

Section: Discussionmentioning

confidence: 99%

Final height and IGF1 in adult survivors of Wilms tumour

Blijdorp

Heuvel‐Eibrink

Pieters

et al. 2013

European Journal of Endocrinology

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Objective: One-sided nephrectomy is followed by increased levels of IGF1, associated with linear growth during childhood. The aim was to evaluate final height and IGF1 levels in nephrectomized Wilms tumour survivors when compared with healthy Dutch references and survivors of other cancer types. Design: Cross-sectional retrospective study. Methods: Data of 575 adult childhood cancer survivors were analysed. Median follow-up time was 17.8 (range 5.0-48.8) years. Analysis of (co)variance was performed to evaluate differences between subgroups: nephrectomized Wilms survivors treated with or without abdominal irradiation (nZ41 and nZ36) and survivors of other cancer types treated with or without irradiation involving the cranium, abdomen or total body (nZ149 and nZ349). Main outcome measures were IGF1 and height, expressed as SDS. Results: After adjustment for age at diagnosis, former corticosteroid treatment and renal impairment, height SDS in non-irradiated nephrectomized Wilms survivors was significantly higher than that in non-irradiated survivors of other cancer types (estimated mean SDS K0.09 vs K0.49, PZ0.044), abdominal irradiated survivors (SDS K0.70, PZ0.015) and other irradiated survivors (SDS K1.47, P!0.001). Non-irradiated nephrectomized Wilms tumour survivors had significantly higher IGF1 SDS than other irradiated survivors (estimated mean SDS K0.05 vs K1.36, P!0.001 and 0.11 vs 1.37, P!0.001), while there was no significant difference with the other two subgroups. Conclusions: Adult survivors of Wilms tumour showed better attainment of final height and relatively higher IGF1 levels than those of other cancer types who had significantly shorter stature and lower IGF1 levels than Dutch references.

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“…Apesar de bons marcadores da deficiência de GH idiopática, sobretudo em idade pré-puberal, o seu papel nos pacientes irradiados é controverso. Alguns estudos mostram que IGF-1 e IGFBP-3 são comumente normais nesta população (14,15). Seus níveis também são normais ou elevados em pacientes que receberam TBI como condicionamento para transplante de medula óssea, mesmo naqueles com picos de GH insuficientes, sugerindo um mecanismo de resistência ao IGF-1 por irradiação das cartilagens ou, ainda, uma deficiência de GH "menos grave" (16).…”

Section: Estudo Da Secreção De Ghunclassified

Seqüelas endócrinas da radioterapia no tratamento do câncer na infância e adolescência

Couto-Silva

Brauner

Adan

2005

Arq Bras Endocrinol Metab

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RESUMOA radioterapia resulta em endocrinopatias, osteoporose, obesidade e seqüelas neurológicas em pacientes tratados por câncer. A deficiência de GH é a complicação mais freqüente no eixo hipotálamo-hipofisário. A freqüência, prazo de surgimento e gravidade da deficiência de GH dependem da dose recebida durante a irradiação craniana, mas idade à radioterapia e fracionamento da dose também são variáveis importantes. Outras anormalidades do eixo hipotálamo-hipofisário são igualmente dose-dependentes. Baixas doses de irradiação induzem puberdade precoce ou avançada, enquanto altas doses provocam deficiência gonadotrópica. Complicações endócrinas secundárias à irradiação periférica, como distúrbios gonadais ou tireoidianos são descritos. Mesmo com secreção normal de GH, o crescimento pode ser comprometido por lesões ósseas após irradiação corporal total ou crânio-espinhal. Resultados melhores sobre a estatura final têm sido obtidos com reposição de GH em associação com o tratamento da puberdade precoce ou avançada. O objetivo desta revisão é a abordagem das seqüelas endócrinas tardias da radioterapia. ABSTRACT Endocrine Sequelae After Radiotherapy in Childhood andAdolescence. Radiotherapy may result in endocrine abnormalities, osteoporosis, obesity and neurological sequelae in patients treated for cancer. In the hypothalamo-pituitary area, GH deficiency is the most frequent complication. The frequency, delay of appearance and severity of GH deficiency depend most on the dose delivered during cranial irradiation but variables as age at treatment and fractionation schedule may play an important role as well. Other hypothalamo-pituitary dysfunctions are also dose-dependent. Low dose cranial irradiation may induce precocious or early puberty, while high doses are related to gonadotropin deficiency. Endocrine complications due to extracranial irradiaton such as gonadal or thyroid abnormalities are described. In spite of normal GH secretion, linear growth may be impaired by bone lesions secondary to craniospinal or total body irradiation. Results on final height have been optimized by better indicators of GH therapy associated with adequate treatment of early or precocious puberty. The purpose of this review is to explore the late endocrine sequelae of radiotherapy.

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The relationship between the growth hormone and insulin‐like growth factor axis in long‐term survivors of childhood brain tumours

Abstract: The difference in serum IGF-1 concentrations between irradiated subjects and controls was greater than the difference in serum IGFBP3. Peak GH activity and the range of activity within the profile correlated strongly with IGF-1 concentrations but less so with IGFBP3.

Cited by 27 publications

References 39 publications

Endocrine Outcome in Long-Term Survivors of Childhood Brain Tumors

Endocrine Outcome in Long-Term Survivors of Childhood Brain Tumors

Final height and IGF1 in adult survivors of Wilms tumour

Seqüelas endócrinas da radioterapia no tratamento do câncer na infância e adolescência

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