title: Endocrine sequelae beyond 10 years in survivors of medulloblastoma.
abstract: BACKGROUND
  Survival following treatment of paediatric medulloblastomas has significantly improved over the past few decades, but as a consequence, late effects, particularly endocrine sequelae, have been recognized. The complete picture of late effects, however, has been limited by short duration of follow-up.
  
  
  OBJECTIVE
  To establish the evolution of endocrine sequelae in patients treated for medulloblastoma.
  
  
  METHODS
  Single-centre analysis of medulloblastoma treatment and endocrine sequelae in patients diagnosed between 1982 and 2002.
  
  
  RESULTS
  A total of 109 patients were treated for medulloblastoma, with various treatment modalities involving radio- and chemotherapy. Only 45 (41%) patients remained alive, and details of treatment and late effects were available for 35 (25 m). The median age at diagnosis was 8 (range 2-14) years, and the median follow-up was 18 (range 10-28) years. Growth hormone deficiency (GHD) was the most prevalent hormone deficiency (97%), followed by primary hypothyroidism (60%) and adrenocorticotrophic hormone (ACTH) deficiency (45·5%). The median time from end of treatment to loss of growth hormone was 1·7 (range 0·7-15) years, ACTH deficiency 2·9 (range 0·75-7·5) years and hypothyroidism 4·1 (range 0·7-11·4) years. Twenty-three percentage developed hypogonadism (17% primary and 6% secondary), whilst precocious puberty was seen in 20%. Endocrinopathies appeared to be more prevalent in those treated with concomitant chemotherapy and radiotherapy.
  
  
  CONCLUSIONS
  Prevalence of endocrine sequelae in medulloblastoma survivors is high, and evolution of endocrine dysfunction can occur as late as 15 years from treatment completion; hence, long-term close monitoring of growth, puberty and gonadal function is essential.
authors.affiliation: Paediatric Endocrinology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Suma
authors.initials: S
authors.lastname: Uday
authors.affiliation: Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Murray
authors.affiliation: Paediatric Oncology & Haematology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Picton
authors.affiliation: Neurosurgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Chumas
authors.affiliation: Paediatric Oncology & Haematology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Midhu
authors.initials: M
authors.lastname: Raju
authors.affiliation: General Paediatrics, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Manju
authors.initials: M
authors.lastname: Chandwani
authors.affiliation: Paediatric Endocrinology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Sabah
authors.initials: S
authors.lastname: Alvi
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects; D004700:Endocrine System Diseases / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents