Precocious puberty and empty sella syndrome in a girl cured of acute lymphoblastic leukemia.
We describe a case of precocious puberty in a girl treated with chemoradiotherapy according to the Italian Association of Pediatric Hematology and Oncology ALL 9503 protocol for acute lymphoblastic leukemia (ALL) from the age of 15 months until the age of 3 years and 4 months. The patient was treated with chemotherapy and cranial irradiation (18 Gy in 12 fractions). At 7 years of age, during topical estrogenic treatment for congenital adhesions of the labia minora, she showed bilateral breast development that evolved into precocious puberty. A magnetic resonance imaging of the brain showed an "empty sella" (ES); the etiology of the ES, and the consequent precocious puberty, being presumably iatrogenic. Children treated with cranial radiotherapy should be carefully checked for signs of precocious puberty and the exogenous administration of estrogens should be avoided, as far as possible, because these could act as a trigger factor in a population at higher risk of precocious puberty.
Department of Pediatrics, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Serena
S
Motta
Valentina
V
Decimi
Angela Ida
AI
Pincelli
Donatella
D
Fraschini
Marco
M
Grimaldi
Momcilo
M
Jankovic
Nicoletta
N
Masera
D059248:Chemoradiotherapy / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004652:Empty Sella Syndrome / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011629:Puberty, Precocious / Q000209:etiology* / Q000473:pathology; D012074:Remission Induction