title: Effects of puberty on bone age maturation in a girl after medulloblastoma therapy.
abstract: BACKGROUND
  Craniospinal radiotherapy for malignant brain tumors can result in a variety of neuroendocrine disturbances, among which are the development of growth hormone deficiency and early puberty, which can markedly reduce adult height.
  
  
  METHODS
  The authors report the case of a girl who received craniospinal radiotherapy for a medulloblastoma at the age of 3.4 years. At 9.1 years, growth hormone therapy was started, and spontaneous onset of puberty (Tanner stage B2) occurred at age 10.3 years. Interval until menarche was short, at only 0.9 years.
  
  
  RESULTS
  Although chronologic age at appearance of Tanner stages was within the normal range, the patient showed a rapid acceleration in skeletal maturation, resulting in adult short stature.
  
  
  CONCLUSIONS
  Bone age seems to be a more precise parameter for biologic maturation in some patients after craniospinal irradiation than is clinical assessment of pubertal stages. Thus, if progression of bone age and decreasing final height predictions are noted, puberty should be stopped with gonadotropin-releasing hormone analogs, even if pubertal development seems to be adequate for chronologic age, because this increases the remaining time for growth hormone treatment.
mesh_terms: D000365:Age Determination by Skeleton; D001827:Body Height / Q000528:radiation effects; D002528:Cerebellar Neoplasms / Q000532:radiotherapy*; D002648:Child; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy / Q000209:etiology*; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D008527:Medulloblastoma / Q000532:radiotherapy*; D011629:Puberty, Precocious / Q000188:drug therapy / Q000209:etiology*