title: Height deficit and impairment of the GH/IGF-1 axis in patients treated for acute lymphoblastic leukemia during childhood.
abstract: BACKGROUND
  Endocrine complications after acute lymphoblastic leukemia (ALL) are common.
  
  
  METHODS
  Final height, GH/IGF-1 axis, and body mass index were analyzed after 13.7 (7.0-20.7) years from diagnosis in 34 boys aged <12 years at diagnosis and 41 girls <10 years at diagnosis. A modified German BFM-83 ALL protocol included (n = 42) or did not include (n = 33) prophylactic cranial irradiation. In 27 patients, GH after insulin tolerance test, IGF-1, cortisol, free T(4) and estradiol/testosterone were determined.
  
  
  RESULTS
  Final height was significantly reduced (mean Z-score for height between final height and diagnosis, ΔHAZ = -0.61, p = 0.0001). At that point, 3 patients were obese (4%) and 17 were overweight (22.7%). Patients aged ≤ 4 years at diagnosis and those irradiated had a greater loss in final height (p = 0.001 and p = 0.008, respectively). Abnormalities in GH/IGF-1 axis were observed in 4 patients: 3 had a GH peak <6 ng/ml and 1 had a serum IGF-1 concentration <25 ng/ml. Growth deficit was significantly higher in patients with hormonal deficiency (p = 0.006).
  
  
  CONCLUSIONS
  Treatment of ALL during childhood is associated with final height deficit. Young age at diagnosis and radiotherapy were the major risk factors. GH/IGF-1 deficiency was found particularly in irradiated patients, even though it was detected in 1 non-irradiated patient.
authors.affiliation: Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil.
authors.forename: Maria Ivone Oliveira Pinto
authors.initials: MI
authors.lastname: Vilela
authors.forename: Marina de Oliveira
authors.initials: Mde O
authors.lastname: Serravite
authors.forename: Natália Bragança
authors.initials: NB
authors.lastname: Oliveira
authors.forename: Patrícia Carneiro
authors.initials: PC
authors.lastname: de Brito
authors.forename: Antônio
authors.initials: A
authors.lastname: Ribeiro-Oliveira
authors.forename: Marcos Borato
authors.initials: MB
authors.lastname: Viana
mesh_terms: D000367:Age Factors; D001827:Body Height / Q000502:physiology; D015992:Body Mass Index; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D013006:Growth Hormone / Q000502:physiology*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000502:physiology*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000503:physiopathology* / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015398:Signal Transduction / Q000502:physiology*; D055815:Young Adult
chemical_list: D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone