title: [Influence of surgery and radiotherapy on growth and pubertal development in children treated for brain tumour].
abstract: BACKGROUND
  The increasing number of childhood cancer survivors has resulted in a growing interest in the late effects, which depend on type of treatment. Frequently, a brain tumour and its therapy in children are endocrinologically devastating.
  
  
  OBJECTIVE
  The aim of study was to compare growth and pubertal development in children after brain tumour therapy treated or not treated with recombinant growth hormone (rGH).
  
  
  METHODS
  18 children were included in this study. Group I - (12/18) not treated with rGH, after total resection of brain tumour: craniopharyngeoma (8/12), astrocytoma (2/12) ependymoma (1/12), germinoma (1/12). Mean time of remission was 5,0yrs (+/- 0,9). Group II - (6/12) treated with rGH, after subtotal resection of craniopharyngeoma (4/6), ependymoma (1/6), medulloblastoma (1/6) and cranial irradiation with mean total doses 46,5 Gy (+/- 5,65). Children were qualified for rGH replacement according to deceleration of growth and lower growth hormone secretion (< 10 ng/ml) in stimulating tests. Mean time of remission was 6,5 yrs (+/- 2,41). Growth, height in centimeters converted to standard deviation score--SDS, body mass index (BMI), pubertal status and hormonal tests, were also evaluated.
  
  
  RESULTS
  All patients were treated with surgery with no cranial irradiation in prepubertal age. 100% children of group I needed substitution because of secondary hypothyreosis, 83% due to secondary adrenal insufficiency and 53% of diabetes insipidus. Mean height after brain tumour surgical treatment in group I was - 1,24 SDS (+/- 0,85) and did not significantly change in the time of observation. Two girls needed hormonal substitution for hypogonadotropic hypogonadism. Mean BMI after total resection of brain tumour was 18,09 (+/- 4,20) and significantly increased to 23,73 (+/- 2,82). In group II - all children presented multihormonal pituitary insufficiency. Mean deviation score of height before rGH treatment was - 3,84 SDS (+/- 2,87) and after mean time of rGH therapy of 1,5 yrs (+/- 1,2) decreased to 2,6 (+/- 1,06). Mean BMI before treatment with rGH 18, 06 (+/- 4,4) increased to 22,41 (+ 0,74) in the time of observation and decreased to 18,5 (+/- 2,87) after 1,5 years (+/- 1,2) of rGH treatment.
  
  
  CONCLUSIONS
  1. Children treated with surgery for brain tumour need substitution for secondary hypothyroidism, part of then need treatment for secondary adrenal and gonadal insufficiency and diabetes incipidus. 2. Children who were treated with surgery and/or cranial irradiation developed multihormonal pituitary insufficiency, growth failure and replacement rGh therapy was needed. 3. Total resection of brain tumour without chemo- and radiotherapy did not impair growth in first years after surgery.
authors.affiliation: Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii AM w Gdańsku. debirkhol@wp.pl
authors.forename: Dorota
authors.initials: D
authors.lastname: Birkholz
authors.forename: Maria
authors.initials: M
authors.lastname: Korpal-Szczyrska
authors.forename: Halina
authors.initials: H
authors.lastname: Kamińska
authors.forename: Ewa
authors.initials: E
authors.lastname: Bień
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Połczyńska
authors.forename: Teresa
authors.initials: T
authors.lastname: Stachowicz-Stencel
authors.forename: Anna
authors.initials: A
authors.lastname: Szołkiewicz
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000150:complications / Q000628:therapy; D001827:Body Height / Q000528:radiation effects; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002648:Child; D016371:Cranial Irradiation / Q000009:adverse effects; D003397:Craniopharyngioma / Q000150:complications / Q000628:therapy; D004806:Ependymoma / Q000150:complications / Q000628:therapy; D005260:Female; D018237:Germinoma / Q000150:complications / Q000628:therapy; D006130:Growth Disorders / Q000188:drug therapy* / Q000209:etiology*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011627:Puberty; D011832:Radiation Injuries / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone