Growth failure after treatment of pediatric brain tumors

• Published in: Pediatrics (Evanston) Vol. 103; no. 3; p. E37
• Main Authors: Clarson, C L, Del Maestro, R F
• Format: Journal Article
• Language: English
• Published: United States 01.03.1999
• Subjects: Adolescent; Antineoplastic Agents - adverse effects; Brain Neoplasms - drug therapy; Brain Neoplasms - physiopathology; Brain Neoplasms - radiotherapy; Child; Child, Preschool; Combined Modality Therapy; Cranial Irradiation - adverse effects; Female; Growth - drug effects; Growth - radiation effects; Growth Disorders - chemically induced; Growth Disorders - etiology; Human Growth Hormone - deficiency; Humans; Hypothyroidism - chemically induced; Hypothyroidism - etiology; Male; Prospective Studies
• ISSN: 1098-4275
• DOI: 10.1542/peds.103.3.e37

Primary brain tumors are the most common solid tumors that occur in childhood. With improved management of these tumors, there are more survivors with long-term sequelae of radiation and chemotherapy including growth failure. The aim of this study was to assess growth prospectively in children with nonpituitary-related primary brain tumors. Forty-one children 3.1 to 13.8 years of age diagnosed consecutively between 1989 and 1992 with a primary nonpituitary-related brain tumor were studied. Of 34 prepubertal children, 14 (41%) were diagnosed as having growth hormone (GH) deficiency. All 14 children were treated with cranial irradiation. During the first year from completion of brain tumor therapy, the annual height velocity of those children confirmed subsequently as being GH-deficient was 3.06 +/- 1.19 cm compared with 5.29 +/- 2.21 cm for those who were not GH-deficient. During the second year, the annual height velocity was 3.29 +/- 1.14 cm per year for the GH-deficient group compared with 5.48 +/- 1.24 cm per year for the non-GH-deficient group. All children with GH deficiency received cranial irradiation and chemotherapy. Two of 34 children developed precocious puberty. Primary hypothyroidism was diagnosed in 6 of 41 children (12%). We conclude that GH deficiency and primary hypothyroidism are common after cranial irradiation and chemotherapy for nonpituitary-related brain tumors. Linear growth appears to reflect GH status accurately in children with brain tumors. Precise auxologic evaluation is simple and noninvasive and may reflect more accurately GH status than provocative GH testing. These findings reflect the need for prospective growth monitoring of children with nonpituitary-related brain tumors treated with cranial irradiation and chemotherapy. Early diagnosis of GH deficiency facilitates early initiation of GH therapy and optimization of final height.