title: A female survivor of childhood medulloblastoma presenting with growth-hormone-induced edema and inflammatory lesions: a case report.
abstract: BACKGROUND
  The improved survival of children with brain tumors has increased concerns about treatment-related sequelae. Growth hormone deficiency is frequently observed after craniospinal irradiation for medulloblastoma. It has been widely reported that growth hormone replacement therapy does not increase the risk of second tumors, but there are reports in the literature of growth hormone, and its downstream mediator insulin-like Growth Factor 1, having an important proinflammatory action. There are few reports, however, on the "in-vivo" induction of edema and symptomatic inflammatory lesions during replacement therapy.
  
  
  METHODS
  We report the case of a 7-year-old girl treated for metastatic medulloblastoma who developed growth hormone deficiency 2 years after oncological treatment.Three months after replacement therapy, magnetic resonance imaging showed exacerbation of her brain edema, which was already present after oncological treatment. We consequently suspended the growth hormone until a new magnetic resonance image obtained 3 months later documented a reduction of the inflammatory areas. We then re-introduced somatotropin at lower doses with no further increase in brain edema in subsequent radiological controls.
  
  
  CONCLUSIONS
  This case and its iconography suggest a strong association between growth hormone administration and the exacerbation of inflammatory reactions within the tumor bed. Replacement therapy should be carefully monitored in this particular subset of patients.
authors.affiliation: Department of Pediatric Oncology, Fondazione IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, 20133 Milan, Italy. veronica.biassoni@alice.it.
authors.forename: Veronica
authors.initials: V
authors.lastname: Biassoni
authors.forename: Federica
authors.initials: F
authors.lastname: Pallotti
authors.forename: Filippo
authors.initials: F
authors.lastname: Spreafico
authors.forename: Ettore
authors.initials: E
authors.lastname: Seregni
authors.forename: Lorenza
authors.initials: L
authors.lastname: Gandola
authors.forename: Antonella
authors.initials: A
authors.lastname: Martinetti
authors.forename: Emilio
authors.initials: E
authors.lastname: Bombardieri
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino