Endocrine conditions common after pediatric brain tumor treatment
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Electronic health records data from a European cohort suggest endocrine secondary effects after pediatric brain tumor treatment develop within 2 years of diagnosis, including pituitary deficiencies, hypothyroidism and obesity.
In an analysis of pediatric patients stratified by brain tumor type — suprasellar vs. non-suprasellar — researchers found both groups had a similar incidence of growth hormone deficiency. However, those with suprasellar tumors had a higher incidence of other pituitary deficiencies and obesity, whereas the non-suprasellar group showed a higher incidence of gonadotoxicity linked to high-dose chemotherapy, primary hypothyroidism and thyroid nodules or cancer related to cervical radiotherapy.
“The division of our population in two different groups, suprasellar and non-suprasellar, is interesting and useful to guide each patient's follow-up, since both groups have a different endocrine disorder profile,” Laura G. González Briceño, MD, of the endocrinology, gynecology and diabetology department at Hôpital Universitaire Necker – Enfants Malades in Paris, told Healio. “Growth hormone deficiency is the most frequent endocrine disorder in both groups, in suprasellar tumors because of the tumor location, but also in non-suprasellar tumors, as a postradiotherapy consequence, when the pituitary radiation dose is at least 18 Gy. Adult height may be impaired, even when GH replacement treatment is given, especially when the patient has been diagnosed at a very young age or when there has been spinal irradiation. Lifelong follow-up is needed to continue surveillance and treat disorders when needed.”
In an observational study, González Briceño and colleagues analyzed medical records data from 221 patients with a history of pediatric primary brain tumor, who had been followed in the pediatric endocrinology unit at Hôpital Universitaire Necker – Enfants Malades between 2010 and 2015. Within the cohort, 48.9% were girls; median age at diagnosis was age 7 years; median follow-up was 6.7 years. Main tumor types were medulloblastoma (37.6%), craniopharyngioma (29%) and glioma (20.4%). According to anatomical location, 48% of tumors were suprasellar and 52% non-suprasellar.
GH deficiency prevalence was similar in both groups, at 83% among those with suprasellar tumors and 76.5% among those with non-suprasellar tumors (P = .338), appearing a median 1.8 years after diagnosis. GH deficiency after radiotherapy appeared a median 1.6 years after radiotherapy. Hypothyroidism was more prevalent among patients with suprasellar tumors vs. non-suprasellar tumors (76.4% vs. 33.9%; P < .001), as was adrenocorticotropic hormone deficiency (69.8% vs. 6.1%; P < .001).
Early puberty incidence was similar in both tumor groups; however, hypogonatropic hypogonadism was more prevalent among patients with suprasellar tumors vs. non-suprasellar (63.1% vs. 1.3%; P < .001). Gonadal toxicity prevalence after chemotherapy was higher among patients with non-suprasellar tumors vs. those with suprasellar tumors (29.6% vs. 2.8%; P < .001).
Researchers observed thyroid nodules in 28.8% of patients, including four cancers. At last follow-up visit, BMI was higher in both groups (P = .0001) and obesity incidence was higher for those with suprasellar vs. non-suprasellar tumors (46.2% vs. 17.4%).
“An early endocrine evaluation is important, especially when the tumor is in the suprasellar area or when there has been hypothalamic or pituitary irradiation,” González Briceño said. “This allows to diagnose and treat endocrine disorders in a timely fashion, since hypothyroidism, corticotrophin deficiency and precocious puberty can be treated even during oncological treatment. Patients with a suprasellar tumor have frequently multiple pituitary deficiencies, whereas patients with a non-suprasellar tumor have a high incidence of early post-radiotherapy growth hormone deficiency; other pituitary deficiencies appear later during follow-up.”
As Healio previously reported, an estimated 40% to 50% of childhood cancer survivors will experience an endocrine disorder in their lifetime. The risk varies according to cancer treatment and can persist for decades after diagnosis.
The researchers noted that so called “late endocrine effects” of treatment for a brain tumor can appear very shortly after cancer treatment, in the first few years of follow-up.
“We must encourage an early referral to the endocrine clinic,” the researchers wrote.
For more information:
Laura González Briceño, MD, can be reached at laura.gonzalezbriceno@aphp.fr.
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