High Prevalence of Early Endocrine Disorders After Childhood Brain Tumors in a Large Cohort.
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González Briceño Laura Gabriela, Kariyawasam Dulanjalee, Samara-Boustani Dinane, Giani Elisa, Beltrand Jacques, Bolle Stéphanie, Fresneau Brice, Puget Stéphanie, Sainte-Rose Christian, Alapetite Claire, Pinto Graziella, Piketty Marie-Liesse, Brabant Séverine, Abbou Samuel, Aerts Isabelle, Beccaria Kevin, Bourgeois Marie, Roujeau Thomas, Blauwblomme Thomas, Di Rocco Federico, Thalassinos Caroline, Pauwels Christian, Rigaud Charlotte, James Syril, Busiah Kanetee, Simon Albane, Bourdeaut Franck, Lemelle Lauriane, Guerrini-Rousseau Léa, Orbach Daniel, Touraine Philippe, Doz François, Dufour Christelle, Grill Jacques, Polak Michel
Аннотация
OBJECTIVE: We aimed to describe the endocrine follow-up of patients with primary brain tumors.
METHODS: This is a noninterventional observational study based on data collection from medical records of 221 patients followed at a Pediatric Endocrinology Department.
RESULTS: Median age at diagnosis was 6.7 years (range, 0-15.9), median follow-up 6.7 years (0.3-26.6), 48.9% female. Main tumor types were medulloblastoma (37.6%), craniopharyngioma (29.0%), and glioma (20.4%). By anatomic location, 48% were suprasellar (SS) and 52% non-suprasellar (NSS). Growth hormone deficiency (GHD) prevalence was similar in both groups (SS: 83.0%, NSS: 76.5%; P = 0.338), appearing at median 1.8 years (-0.8 to 12.4) after diagnosis; postradiotherapy GHD appeared median 1.6 years after radiotherapy (0.2-10.7). Hypothyroidism was more prevalent in SS (76.4%), than NSS (33.9%) (P < 0.001), as well as ACTH deficiency (SS: 69.8%, NSS: 6.1%; P < 0.001). Early puberty was similar in SS (16%) and NSS (12.2%). Hypogonadotropic hypogonadism was predominant in SS (63.1%) vs NSS (1.3%), P < 0.001, and postchemotherapy gonadal toxicity in NSS (29.6%) vs SS (2.8%), P < 0.001. Adult height was lower for NSS compared to target height (-1.0 SD, P < 0.0001) and to SS patients (P < 0.0001). Thyroid nodules were found in 13/45 patients (28.8%), including 4 cancers (4.8-11.5 years after radiotherapy). Last follow-up visit BMI was higher in both groups (P = 0.0001), and obesity incidence was higher for SS (46.2%) than NSS (17.4%).
CONCLUSION: We found a high incidence of early-onset endocrine disorders. An endocrine consultation and nutritional evaluation should be mandatory for all patients with a brain tumor, especially when the tumor is suprasellar or after hypothalamus/pituitary irradiation.