Growth Response to GH therapy in Children with Radiation-Induced GH deficiency

Abstract

Six children who received cranial irradiation for brain tumours which did not directly involve the hypothalamic-pituitary axis, were studied. The radiation dose received by the hypothalamic-pituitary axis ranged from 3000-4750 rads (over 3 weeks).Pituitary function was assessed between 2 and 10 years after DXT and impaired GH responses to insulin hypoglycaemia and Bovril stimulation tests were seen in all subjects. The remainder of pituitary function was essentially normal. The bone age was retarded in 5 of the 6 subjects and the initial standing height SDS varied between -1.7 and -3.3. During the pre-treatment year the children, all of whom were prepubertal, grew between 2.0 and 5.1 cm.Subsequently all received 5 units GH 3 times weekly for 1 year.The growth rate of each child was at least 2 cm. greater during the treatment year (range 6.0 to 10.1cm.) than the pre-treatment year.In 5 of the 6 the improved growth rate could be totally ascribed to GH therapy. In the sixth there was significant pubertal maturation during the treatment year and only in this subject did the bone age advance at a significantly greater rate than the chronological age.We conclude that radiation-induced GH deficiency is one of several important factors in the aetiology of short stature complicating the treatment of brain tumours in childhood. If such a child is clinically well,shows a poor growth rate and biochemical evidence of GH deficiency,then a 1 year trial of GH is justified.

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