title: Final height in children with medulloblastoma treated with growth hormone.
abstract: BACKGROUND
  Medulloblastoma is the most frequent primary solid central nervous system tumour in children. The 5-year survival rate is at present at about 60%. Height in general is severely compromised in survivors. The present study is an extension of the investigation by the author's group of the effect of exogenous growth hormone (GH) among medulloblastoma patients.
  
  
  METHODS
  A total of 113 patients with medulloblastoma (out of 682 cases documented in KIGS, Pfizer International Growth Database) were treated with GH till final height was achieved. At the start of GH therapy (median dose 0.18 mg/kg/week), patients were 8.9 years old and had a median height SDS of -1.6.
  
  
  RESULTS
  After 6.8 years of GH, final height SDS was -1.9, reflecting an overall loss in height of 0.3 SDS. This contrasted with an age-matched group of patients with idiopathic growth hormone deficiency (iGHD, n = 1,986), whose gain in height was 1.6 SDS on the same dose. The index of responsiveness averaged -0.9 during the first prepubertal year and -2.0 during total pubertal growth, thus indicating a major impairment in responsiveness to GH as compared to iGHD. Height at GH start, which correlated positively with the age at disease onset, was found to be the major determinant of final height.
  
  
  CONCLUSIONS
  Our findings show that attempts to improve the height outcome in medulloblastoma must involve earlier recognition and treatment with higher-than-replacement doses of GH; additionally, modifications in cancer treatment programs need to be considered, such as lowering the dose of craniospinal irradiation or avoiding it as far as possible.
authors.affiliation: Paediatric Endocrinology Section, Children's Hospital, University of Tubingen, Tubingen, Germany. Michael.Ranke@med.uni-tuebingen.de
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ranke
authors.forename: David A
authors.initials: DA
authors.lastname: Price
authors.forename: Anders
authors.initials: A
authors.lastname: Lindberg
authors.forename: Patrick
authors.initials: P
authors.lastname: Wilton
authors.forename: Feyza
authors.initials: F
authors.lastname: Darendeliler
authors.forename: Edward O
authors.initials: EO
authors.lastname: Reiter
mesh_terms: D000293:Adolescent; D000328:Adult; D001827:Body Height / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000188:drug therapy / Q000209:etiology; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000150:complications* / Q000628:therapy; D011627:Puberty / Q000502:physiology; D018709:Statistics, Nonparametric
chemical_list: D019382:Human Growth Hormone