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Endocrine disorders prevalent among childhood brain tumor survivors
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Approximately 22.1% of childhood brain tumor survivors developed at least one endocrine disorder within 5 years after diagnosis, according to a nationwide, multicenter study.
“Endocrine disorders after cancer treatment may have a significant negative influence on health, especially during childhood,” Hanneke M. van Santen, MD, PhD, pediatric endocrinologist at Wilhelmina Children’s Hospital at the University Medical Center Utrecht in the Netherlands, and colleagues wrote. “In children who survive a brain tumor, adequate concentrations of circulating hormones are essential for adequate recovery and for development and growth into adolescence and optimal daily (school) life participation, which underlines the importance of on-time surveillance of an intact endocrine system.”
Endocrine disorders may occur within the first 5 years after diagnosis; however, current guidelines differ in proposed screening methods and appropriate time intervals.
Therefore, van Santen and colleagues evaluated the prevalence of and risk factors for early endocrine disorders in 718 childhood brain tumor survivors diagnosed between 2002 and 2012.
After a median follow-up of 6.6 years, 178 survivors (24.8%) had been diagnosed with an endocrine disorder at diagnosis or during follow-up. Of those with an endocrine disorder, 51.1% had more than one.
The most common endocrine disorders included growth hormone deficiency (12.5%), precocious puberty (12.2%), thyroid-stimulating hormone deficiency (9.2%) and thyroidal hypothyroidism (5.8%).
Median follow-up time from primary brain tumor diagnosis to diagnosis of the first endocrine disorder occurred at 2.2 years. The 5-year cumulative incidence was 20.9% (95% CI, 15.6-26.7).
Dysfunction of at least one pituitary axis occurred in 19.2% of survivors (n = 138) at a median follow-up of 2.5 years after diagnosis (5-year cumulative incidence, 15%; 95% CI, 9.8-21.2).
Associations with risk for hypothalamic-pituitary dysfunction included radiotherapy (OR = 15.74; 95% CI, 8.72-28.42), younger age at diagnosis (OR = 1.09; 95% CI, 1.04-1.14), advanced follow-up time (OR = 1.1; 95% CI, 1.02-1.18), hydrocephalus at diagnosis (OR = 1.77; 95% CI, 1.09-2.88), and suprasellar (OR = 34.18; 95% CI, 14.74-79.29) and infratentorial (OR = 2.65; 95% CI, 1.48-4.74) tumor site.
In addition, survivors who received radiotherapy at doses of more than 30 Gy demonstrated an increased risk for developing hypothalamic-pituitary dysfunction (30-39.9 Gy; HR = 5.04; 95% CI, 1.39-18.25; > 40 Gy; HR = 13.03; 95% CI, 3.13-54.26).
“Our findings highlight the need of early and regular standardized clinical and laboratory assessments of hypothalamic-pituitary function in at-risk childhood brain tumor survivors,” the researchers wrote.
“Because timely diagnosis and adequate hormone replacement therapy can contribute significantly to the well-being of childhood brain tumor survivors, an international guideline for early endocrine assessments is currently under development and may potentially enable prospective, international registration of endocrine disorders in childhood brain tumor survivors,” they added. – by Kristie L. Kahl
Disclosure: Santen reports research funding from Pfizer and travel accommodations and expenses from Ferring. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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