Claude Fabien, Ubertini Graziamaria, Szinnai Gabor
Department of Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, University of Basel, 4056 Basel, Switzerland.
Department of Pediatric Endocrinology, Bambino Gesù Children's Hospital, 00165 Rome, Italy.
Children (Basel). 2022 Oct 25;9(11):1617. doi: 10.3390/children9111617.
Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic-pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic-pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents.
Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.
脑肿瘤是所有儿童恶性肿瘤中第二常见的类型。根据其位置，脑肿瘤患者可能出现神经或眼科症状，还可能出现体重异常和内分泌紊乱，范围从生长激素缺乏、青春期异常、尿崩症到全垂体功能减退。在诊断时，所有脑肿瘤患者都需要对下丘脑 - 垂体功能进行全面评估，以应对可能出现的内分泌紊乱。此外，接受脑部手术的儿童和青少年必须接受围手术期和术后氢化可的松应激治疗。术后水稳态紊乱很常见，从短暂性尿崩症、抗利尿激素分泌不当综合征到持续性尿崩症。晚期内分泌紊乱可能由下丘脑 - 垂体区域附近或内部的手术引起。放疗后垂体功能缺陷很常见，尤其是生长激素缺乏。放疗数年之后可能出现甲状腺结节或继发性甲状腺癌。化疗后性腺功能障碍很常见，尤其是使用烷化剂时。
在诊断时、围手术期以及长期随访期间早期发现并治疗特定的内分泌紊乱，可改善总体健康和代谢状况以及生活质量。
