Talvensaari K K, Lanning M, Pääkkö E, Tapanainen P, Knip M
Department of Pediatrics, University of Oulu, Finland.
J Clin Endocrinol Metab. 1994 Oct;79(4):1122-7. doi: 10.1210/jcem.79.4.7525626.
We investigated 37 long term survivors of childhood cancer to study the relationship among growth, GH secretion, and pituitary size. The median follow-up time after diagnosis was 13.2 yr. The pituitary gland was visualized with magnetic resonance imaging. Radiated patients (n = 25) had a reduced relative height and showed a greater reduction in relative height after diagnosis than nonradiated patients (n = 12). The patients had lower spontaneous nocturnal GH secretion than controls due to a reduced peak amplitude. Spontaneous GH secretion was lower in radiated patients than in nonradiated subjects. The patients had lower plasma insulin-like growth factor-I (IGF-I) and serum IGF-binding protein-3 (IGFBP-3) concentrations than the controls. Radiated subjects had decreased IGF-I and IGFBP-3 concentrations compared to nonradiated subjects. Half of the patients (20 of 37) evaluated with magnetic resonance imaging had a reduced pituitary size (pituitary height, < -2 SD score). Radiated subjects had smaller pituitary glands than nonradiated ones. Seventeen of 20 patients (85%) with reduced pituitary size had decreased nocturnal GH release. There was a positive correlation between nocturnal GH secretion, plasma IGF-I, and serum IGFBP-3 levels, on the one hand, and pituitary height, on the other. These results indicate that cranial radiation may result in tissue damage, leading to decreased pituitary size, reduced spontaneous GH secretion, and impaired linear growth. The finding of reduced IGF-I levels in both radiated and nonradiated patients combined with decreased IGFBP-3 concentrations in radiated patients, indicates that cytotoxic chemotherapy may induce hepatic damage resulting in decreased IGF-I synthesis.
我们对37名儿童癌症长期幸存者进行了调查，以研究生长、生长激素（GH）分泌和垂体大小之间的关系。诊断后的中位随访时间为13.2年。通过磁共振成像观察垂体。接受放疗的患者（n = 25）相对身高降低，且诊断后相对身高的降低幅度大于未接受放疗的患者（n = 12）。由于峰值幅度降低，这些患者的自发性夜间GH分泌低于对照组。接受放疗的患者的自发性GH分泌低于未接受放疗的患者。这些患者的血浆胰岛素样生长因子-I（IGF-I）和血清IGF结合蛋白-3（IGFBP-3）浓度低于对照组。与未接受放疗的受试者相比，接受放疗的受试者的IGF-I和IGFBP-3浓度降低。在接受磁共振成像评估的患者中，一半（37名中的20名）垂体大小减小（垂体高度，< -2标准差评分）。接受放疗的受试者的垂体比未接受放疗的受试者小。垂体大小减小的20名患者中有17名（85%）夜间GH释放减少。一方面，夜间GH分泌、血浆IGF-I和血清IGFBP-3水平与另一方面的垂体高度之间存在正相关。这些结果表明，颅脑放疗可能导致组织损伤，导致垂体大小减小、自发性GH分泌减少和线性生长受损。在接受放疗和未接受放疗的患者中均发现IGF-I水平降低，以及接受放疗的患者中IGFBP-3浓度降低，这表明细胞毒性化疗可能诱导肝损伤，导致IGF-I合成减少。
