Hypothalamic-pituitary dysfunction in survivors of childhood brain tumors in Prasat Neurological Institute.
OBJECTIVE
To assess hypothalamic-pituitary dysfunction in childhood brain tumor survivors in Prasat Neurological Institute.


METHODS
Between October 2007 and September 2008, 19 brain tumor survivor children in Prasat Neurological Institute without recurrence at least 2 years after complete treatment were included in the present study. The patients were categorized according to brain tumor location into directly (DHPA) (9 cases) and indirectly (IDHPA) (10 cases) involving hypothalamic-pituitary axis. All patients were treated by surgery. Furthermore, six cases were combined with radiation and chemotherapy and 10 cases were combined with radiation therapy only. Growth Hormone (GH) stimulation test by clonidine and/or L-Dopa, ACTH stimulation test and thyroid function test (TFT) were done.


RESULTS
The mean age at diagnosis was 9.9 +/- 4.6 years old and the interval from diagnosis to study was 5.8 +/- 2.2 years. Seven DHPA (77%) and seven IDHPA patients (70%) had low peak GH with significant lower level in the former group (p < 0.05). Six of seven DHPA (85%) and one IDHPA patients (10%) had low response to ACTH stimulation test. All DHPA (100%) and 10% IDHPA patients had central hypothyroidism. By ACTH stimulation test in DHPA patients, hypocortisolism was detected in five and excluded in one who later stopped prednisolone after prolonged continuation. The central hypothyroidism was newly detected in two DHPA patients and replacement therapy was initiated GH deficiency (GHD) was detected by GH stimulation test in 73% of overall brain tumors. Growth hormone therapy would be considered in the appropriate GHD patients.


CONCLUSIONS
With effective therapy and improving survival rates of brain tumor children, hypothalamic-pituitary dysfunction in either DHPA or IDHPA group should be regularly monitored to prevent further morbidity and improve quality of life.
Lusawat
Apasri
A
Department ofPediatric Neurology, Prasat Neurological Institute, Bangkok, Thailand. lusawat@hotmail.com
Dhiravibulya
Kanlaya
K
Thammongkol
Sasipa
S
Vanavanan
Somlak
S
Mahachoklertwattana
Pat
P
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D001932:Brain Neoplasms / Q000150:complications* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007027:Hypothalamic Diseases / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D010900:Pituitary Diseases / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D017741:Survivors; D013785:Thailand / Q000453:epidemiology; D013960:Thyroid Function Tests
D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone