Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Pediatr Blood Cancer. 2020 Dec;67(12):e28723. doi: 10.1002/pbc.28723. Epub 2020 Oct 10.
To determine the impact of hypothalamic-pituitary (HP) disorders on health outcomes in children and adolescents who received conformal radiation therapy (RT) for central nervous system tumors.
Cohort study including 355 patients (age ≤25 years at diagnosis) treated with high-dose (50.4-59.4 Gy) RT using photons for low-grade glioma or ependymoma. Patients (median age, 6.4 years at RT) received systematic endocrine follow-up (median duration, 10.1 years; range, 0.1-19.6). Associations between HP disorders and adverse health outcomes were determined by multivariable analysis.
Prevalence was 37.2% for growth hormone deficiency (GHD), 17.7% for gonadotropin deficiency (LH/FSHD), 14.9% for thyroid-stimulating hormone deficiency (TSHD), 10.3% for adrenocorticotropic hormone deficiency (ACTHD), and 12.6% for central precocious puberty (CPP). Hypothalamus mean dose ≥ 36 Gy was associated with higher odds of any deficiency. GHD was associated with short stature (OR 2.77; 95% CI 1.34-5.70), low bone mineral density (OR 3.47; 95% CI 1.16-10.40), and TSHD with dyslipidemia (OR 5.54; 95% CI 1.66-18.52). Patients with ACTHD and CPP had lower intelligence quotient scores, and memory scores were impaired in patients with GHD (P = 0.02). Treatment of GHD was not associated with increased risk for tumor recurrence, secondary tumors, or mortality.
HP disorders occur frequently in patients receiving high-dose RT and are related to physical and neurocognitive well-being. Future studies are needed to assess whether further optimization of endocrine management yields better health outcomes.
为了确定下丘脑-垂体（HP）功能障碍对接受中枢神经系统肿瘤适形放射治疗（RT）的儿童和青少年健康结果的影响。
这是一项包括 355 名患者（诊断时≤25 岁）的队列研究，他们接受了高强度（50.4-59.4 Gy）光子 RT 治疗低级别胶质瘤或室管膜瘤。患者（中位年龄，RT 时 6.4 岁）接受了系统的内分泌随访（中位持续时间 10.1 年；范围 0.1-19.6）。通过多变量分析确定 HP 功能障碍与不良健康结果之间的关联。
生长激素缺乏症（GHD）的患病率为 37.2%，促性腺激素缺乏症（LH/FSHD）为 17.7%，促甲状腺激素缺乏症（TSHD）为 14.9%，促肾上腺皮质激素缺乏症（ACTHD）为 10.3%，中枢性性早熟（CPP）为 12.6%。下丘脑平均剂量≥36 Gy 与更高的任何缺乏症几率相关。GHD 与身材矮小（OR 2.77；95%CI 1.34-5.70）、骨密度低（OR 3.47；95%CI 1.16-10.40）和 TSHD 与血脂异常（OR 5.54；95%CI 1.66-18.52）相关。患有 ACTHD 和 CPP 的患者智商得分较低，患有 GHD 的患者记忆得分受损（P=0.02）。GHD 的治疗与肿瘤复发、继发性肿瘤或死亡率的增加无关。
接受高剂量 RT 的患者中 HP 功能障碍频繁发生，与身体和神经认知健康有关。需要进一步研究以评估内分泌管理的进一步优化是否会带来更好的健康结果。
