926 LONG TERM ENDOCRINE SEQUELAE IN MEDULLOBLASTOMA PATIENTS

Abstract

Over 50% of pts. with medulloblastoma who receive conventional therapy with craniospinal irradiation will be alive and free of disease five yrs. from diagnosis. Endocrine evaluation was performed in 22 pts. aged 2½-23½ yrs. at time of diagnosis, status post treatment for medulloblastoma. Evaluations were performed 2 mos. to 6 3/4 yrs. after diagnosis. The pts. received either 12 mos. of chemotherapy and/or radiation therapy. The mean radiation dose to the neuraxis and hypothalamus was 3600 rads. Three pts. had completed their growth prior to onset of disease. Post-treatment, decreased growth rates were observed in 13 pts. Only 3 of 10 pts. tested had deficient GH response to stimulation. Elevated TSH levels were noted in 15 pts. with abnormal TSH responses to TRH in 13 of 13 tested. Compensated thyroidal hypothyroidismwas observed in 13 pts., 1 patient each had thyroidal hypothyroidism, or hypothalamic hypothyroidism. We conclude that an abnormal growth rate associated with a normal GH response to standard stimuli, postulated to be caused by growth hormone neurosecretory dysfunction, and compensated hypothyroidism are frequent complications of therapy for medulloblastoma. Further, standard provocative tests of GH reserve are inadequate to define neurosecretory growth dysfunction; a trial of GH treatment may be indicated in children with poor growth rates. In addition, treatment with thyroid hormone of patients with compensated hypothyroidism should be considered. These therapies may allow achievement of normal growth and development and thus, decrease survivor's morbidity.

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