Adan L, Trivin C, Sainte-Rose C, Zucker J M, Hartmann O, Brauner R
Pediatric Endocrinology, Université René Descartes and Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, France.
J Clin Endocrinol Metab. 2001 Nov;86(11):5245-51. doi: 10.1210/jcem.86.11.8056.
Cranial irradiation alters hypothalamic-pituitary function. We reevaluated 90 patients with GH deficiency caused by fractionated cranial irradiation performed at age 4.9 +/- 0.4 (SE) yr when they were 15.7 +/- 0.2 yr old. Group 1 received 18 Grays (Gy) (7 cases) or 24 Gy (21 cases) for acute lymphoblastic leukemia; group 2, 30-40 Gy for medulloblastoma (22 cases); group 3, 45-60 Gy for optic glioma and various tumors (30 cases); and group 4, 40-50 Gy for retinoblastoma (10 cases). The mean GH peaks after an arginine insulin test in group 3 (1.9 +/- 0.4 microg/liter) was lower than in groups 1 (4.8 +/- 0.5 microg/liter, P < 0.001) and 2 (3.4 +/- 0.5 microg/liter, P < 0.03). The mean plasma IGF-I concentrations in group 3 [-3.8 +/- 0.2 z score (zs)] was lower than in groups 1 (-2.4 +/- 0.3 zs, P < 0.001) and 2 (-3.1 +/- 0.2 zs, P < 0.02), as was the mean in group 4 (-3.9 +/- 0.3 zs, P < 0.01 compared with group 1 and P < 0.05 compared with group 2). GH peaks and IGF-I were correlated positively (P = 0.0001) and negatively with dose (P < 0.001 for GH and P = 0.0001 for IGF-I), but not with age at irradiation. Among the 43 patients with GH peaks below 3 microg/liter, 41 (95%) had plasma IGF-I less than -2 zs. The body mass index (BMI), plasma insulin, and leptin were similar in the four groups. They were positively correlated with each other (P < 0.001 for BMI compared with insulin and with leptin, respectively, and P < 0.01 for insulin compared with leptin), but not with age or dose of irradiation, or with markers of GH secretion. In conclusion, in patients with GH deficiency caused by cranial irradiation, the residual GH secretion and plasma IGF-I depend on the dose. Almost all the patients with severe GH deficiency had low plasma IGF-I. BMI, leptin, and insulin seem to be independent of GH status.
头颅照射会改变下丘脑 - 垂体功能。我们重新评估了90例因在4.9±0.4（标准误）岁时接受分次头颅照射而导致生长激素（GH）缺乏的患者，他们在15.7±0.2岁时接受评估。第1组因急性淋巴细胞白血病接受18戈瑞（Gy）（7例）或24 Gy（21例）照射；第2组，因髓母细胞瘤接受30 - 40 Gy照射（22例）；第3组，因视神经胶质瘤和各种肿瘤接受45 - 60 Gy照射（30例）；第4组，因视网膜母细胞瘤接受40 - 50 Gy照射（10例）。第3组精氨酸胰岛素试验后的平均GH峰值（1.9±0.4微克/升）低于第1组（4.8±0.5微克/升，P<0.001）和第2组（3.4±于0.5微克/升，P<0.03）。第3组的平均血浆胰岛素样生长因子 - I（IGF - I）浓度[-3.8±0.2标准差分数（zs）]低于第1组（-2.4±0.3 zs，P<0.001）和第2组（-3.1±0.2 zs，P<0.02），第4组的平均浓度（-3.9±0.3 zs，与第1组相比P<0.01，与第2组相比P<0.05）也是如此。GH峰值与IGF - I呈正相关（P = 0.0001），与剂量呈负相关（GH为P<0.001，IGF - I为P = 0.0001），但与照射时的年龄无关。在43例GH峰值低于3微克/升的患者中，41例（95%）血浆IGF - I低于 - 2 zs。四组患者的体重指数（BMI）、血浆胰岛素和瘦素相似。它们彼此呈正相关（BMI与胰岛素和瘦素相比，P均<0.001；胰岛素与瘦素相比，P<0.01），但与年龄、照射剂量或GH分泌标志物无关。总之，在因头颅照射导致GH缺乏的患者中，残余的GH分泌和血浆IGF - I取决于照射剂量。几乎所有严重GH缺乏的患者血浆IGF - I都较低。BMI、瘦素和胰岛素似乎与GH状态无关。
