title: Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours: presentation and long-term outcomes.
abstract: OBJECTIVE
  To estimate the prevalence of central precocious puberty (CPP) after treatment for tumours and malignancies involving the central nervous system (CNS) and examine repercussions on growth and pubertal outcomes.
  
  
  METHODS
  Retrospective study of patients with tumours near and/or exposed to radiotherapy to the hypothalamus/pituitary axis (HPA).
  
  
  METHODS
  Patients with CPP were evaluated at puberty onset, completion of GnRH agonist treatment (GnRHa) and last follow-up. Multivariable analysis was used to test associations between tumour location, sex, age at CPP, GnRHa duration and a diagnosis of CPP with final height <-2SD score (SDS), gonadotropin deficiency (LH/FSHD) and obesity, respectively.
  
  
  RESULTS
  Eighty patients (47 females) had CPP and were followed for 11·4 ± 5·0 years (mean ± SD). The prevalence of CPP was 15·2% overall, 29·2% following HPA tumours and 6·6% after radiotherapy for non-HPA tumours. Height <-2SDS was more common at the last follow-up than at the puberty onset (21·4% vs 2·4%, P = 0·005). Obesity was more prevalent at the last follow-up than at the completion of GnRHa or the puberty onset (37·7%, 22·6% and 20·8%, respectively, P = 0·03). Longer duration of GnRHa was associated with increased odds of final height <-2SDS (OR = 2·1, 95% CI 1·0-4·3) and longer follow-up with obesity (OR = 1·3, 95% CI 1·1-1·6). LH/FSHD was diagnosed in 32·6%. There was no independent association between CPP and final height <-2SDS, and LH/FSHD and obesity in the subset of patients with HPA low-grade gliomas.
  
  
  CONCLUSIONS
  Patients with organic CPP experience an incomplete recovery of growth and a high prevalence of LH/FSHD and obesity. Early diagnosis and treatment of CPP may limit further deterioration of final height prospects.
authors.affiliation: Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.|Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Wassim
authors.initials: W
authors.lastname: Chemaitilly
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Barnes
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.|Division of Cancer Survivorship, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.|Division of Cancer Survivorship, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Department of Pediatrics, Memorial - Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
mesh_terms: D001827:Body Height; D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005640:Follicle Stimulating Hormone / Q000172:deficiency; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D007031:Hypothalamus / Q000528:radiation effects; D007223:Infant; D007986:Luteinizing Hormone / Q000172:deficiency; D008297:Male; D009765:Obesity / Q000209:etiology; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010910:Pituitary Irradiation / Q000009:adverse effects; D011629:Puberty, Precocious / Q000175:diagnosis* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone