Preirradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function.
OBJECTIVE
To prospectively evaluate pediatric patients with localized primary brain tumors for evidence of endocrinopathy before radiotherapy (RT).


METHODS
Seventy-five pediatric patients were evaluated with the arginine tolerance test and L-dopa test for growth hormone secretory capacity and activity; thyroid-stimulating hormone surge and thyrotropin-releasing hormone stimulation test for the hypothalamic-thyroid axis; the 1-microg adrenocorticotropin hormone (ACTH) and metyrapone test for ACTH reserve; and, depending on age, a gonadotropin-releasing hormone stimulation test to determine gonadotropin response. The study included 38 male and 37 female patients, age 1-21 years with ependymoma (n = 35), World Health Organization (WHO) Grade I-II astrocytoma (n = 18), WHO Grade III-IV astrocytoma (n = 10), craniopharyngioma (n = 7), optic pathway tumor (n = 4), and germinoma (n = 1). Seven patients receiving dexamethasone at the time of the evaluation were excluded from the final analysis.


RESULTS
Of 68 assessable patient, 45 (66%) had evidence of endocrinopathy before RT, including 15 of 32 patients (47%) with posterior fossa tumors. Of the 45 patients, 38% had growth hormone deficiency, 43% had thyroid-stimulating hormone secretion abnormality, 22% had an abnormality in ACTH reserve, and 13% had an abnormality in age-dependent gonadotropin secretion.


CONCLUSIONS
The incidence of pre-RT endocrinopathy in pediatric brain tumor patients is high, including patients with tumors not adjacent to the hypothalamic-pituitary unit. These data suggest an overestimation in the incidence of radiation-induced endocrinopathy. Baseline endocrine function should be determined for brain tumor patients before therapy. The potential for radiation-induced endocrinopathy alone cannot be used as an argument for alternatives to RT for most patients. Pre-RT endocrinopathy may be an early indicator of central nervous system damage that will influence the functional outcome unrelated to RT.
Department of Radiation Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105, USA. thomas.merchant@stjude.org
Thomas E
TE
Merchant
Tani
T
Williams
Julie M
JM
Smith
Susan R
SR
Rose
Robert K
RK
Danish
George A
GA
Burghen
Larry E
LE
Kun
Robert H
RH
Lustig
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D004702:Endocrine Glands / Q000503:physiopathology*; D004700:Endocrine System Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D013972:Thyrotropin / Q000378:metabolism
D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin