Children with brain tumors may have hypothyroidism
and other endocrine problems after treatment
(March 2003)
The background of
the study. Children with brain tumors who survive for many
years may have endocrine and other adverse effects of treatment.
This study was done to determine the frequency of endocrine and
cardiovascular effects of treatment in long-term survivors of brain
tumors.
How the study was done. The study
subjects were 1607 children, adolescents, and young adults treated
for a brain tumor between 1970 and 1986 who survived for at least
five years after diagnosis. They were queried by mail or telephone
about thyroid dysfunction and therapy, growth hormone deficiency
and therapy, pubertal development and treatment of pubertal delay,
and cardiovascular problems. At the time of diagnosis of brain tumor,
34 percent were ≤4 years old; 30 percent were 5 to 9 years
old, and 36 percent were ≥10 years old. Most of the patients
had an astrocytoma/glioma or medulloblastoma.
The results of the study. Sixteen
percent of the patients had hypothyroidism; 21 percent had growth
hormone deficiency, many of whom were treated with injections of
growth hormone; 6 percent received some treatment to induce pubertal
development. Less common problems were hyperthyroidism (1 percent),
thyroid enlargement or nodules (2 percent), failure of onset of
menstrual periods (2 percent), and low sperm counts (1 percent).
All these problems and treatments were most common in the patients
treated with surgery, radiation, and chemotherapy and least common
in those treated with surgery alone.
Overall 18 percent had one adverse cardiovascular outcome or more
(stroke, arrhythmia, blood clots, chest pain), of which stroke was
the most common (5 percent).
The conclusions of the study. Among
children with brain tumors who survive for five or more years after
treatment, hypothyroidism and other endocrine problems are common.
The original article. Gurney JG,
Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, Stovall
M, Yasui Y, Nicholson HS, Wolden S, McNeil DE, Mertens AC, Robison
LL. Endocrine and cardiovascular late effects among adult survivors
of childhood brain tumors: Childhood Cancer Survivor Study. Cancer
2003;97:663-73.
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