Rinnekoti Foundation, Espoo, Finland.
Department of Hematology, Cancer Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
Acta Paediatr. 2017 Oct;106(10):1684-1693. doi: 10.1111/apa.13975. Epub 2017 Aug 3.
Childhood brain tumour survivors have a high risk of endocrine morbidity. This study evaluated the growth, pubertal development and gonadal function in survivors of childhood brain tumours and identified factors associated with the problems we observed.
The 52 subjects (52% male) were diagnosed in 1983-1997 and treated for brain tumours at Tampere University Hospital, Finland. They were followed up at a mean age of 14.2 (3.8-28.7) years, a mean of 7.5 (1.5-15.1) years after diagnosis.
We found that 30 (58%) participants had a lower height standard deviation score at follow-up than at diagnosis and short stature at follow-up was associated with tumour malignancy (p = 0.005), radiotherapy (p = 0.004), chemotherapy (p = 0.024), growth hormone deficiency (p < 0.001), hypogonadism (p = 0.044) and delayed puberty (p = 0.021). We found that five needed sex hormones to induce puberty, one had precocious puberty, 12 (23%) had growth hormone deficiency and eight (22%) of the 36 pubertal or postpubertal patients had hypogonadism. Testicular volume was low in 83% of late or postpubertal male survivors.
Growth impairment, growth hormone deficiency and hypogonadism were common in childhood brain tumour survivors and low testicular volume was also common in male survivors. Lifelong annual follow-up checks are indicated for survivors.
儿童脑瘤幸存者有很高的内分泌发病率。本研究评估了儿童脑瘤幸存者的生长、青春期发育和性腺功能,并确定了与我们观察到的问题相关的因素。
52 名受试者(52%为男性)于 1983-1997 年在芬兰坦佩雷大学医院诊断为脑瘤,并接受治疗。他们在平均年龄为 14.2 岁(3.8-28.7 岁)时进行了随访,平均在诊断后 7.5 岁(1.5-15.1 岁)时进行了随访。
我们发现,30 名(58%)参与者在随访时的身高标准差评分低于诊断时,且随访时身材矮小与肿瘤恶性程度(p=0.005)、放疗(p=0.004)、化疗(p=0.024)、生长激素缺乏症(p<0.001)、性腺功能减退症(p=0.044)和青春期延迟(p=0.021)有关。我们发现,有 5 人需要性激素来诱导青春期,1 人出现性早熟,12 人(23%)有生长激素缺乏症,36 名青春期或青春期后的患者中有 8 人(22%)有性腺功能减退症。晚期或青春期后男性幸存者的睾丸体积低者占 83%。
生长障碍、生长激素缺乏症和性腺功能减退症在儿童脑瘤幸存者中很常见,睾丸体积低在男性幸存者中也很常见。建议对幸存者进行终身每年随访检查。