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Normal growth despite abnormalities of growth hormone secretion in children treated for acute leukemia
Insights
Children treated for acute lymphatic leukemia (ALL) often have growth issues post-cranial irradiation. While most showed reduced growth hormone (GH) response, few were clinically GH deficient, suggesting limited benefit from GH therapy.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
Background:
- Cranial irradiation is a common treatment for acute lymphatic leukemia (ALL).
- Growth disturbances are a known sequela of cranial irradiation in children.
Purpose of the Study:
- To investigate the relationship between the growth hormone-somatomedin axis and growth in children treated for ALL.
- To assess the impact of cranial irradiation dosage on growth parameters and hormonal responses.
Main Methods:
- Studied 26 children in remission from ALL who had received cranial irradiation.
- Assessed standing height, height velocity, somatomedin activity, bone age, and peak growth hormone (GH) response to pharmacologic stimuli (insulin hypoglycemia and arginine test).
- Compared outcomes between children receiving higher versus lower doses of cranial irradiation and with age-matched controls.
Main Results:
- Mean standing height SDS was significantly less than normal in the studied children.
- No significant differences in height SDS, height velocity SDS, somatomedin activity, or bone age retardation were found between irradiation dose groups or compared to controls.
- Peak GH responses to insulin hypoglycemia and arginine were significantly lowered in both irradiation groups compared to controls.
Conclusions:
- Most children treated for ALL with cranial irradiation exhibit reduced GH response to stimuli, but few are clinically GH deficient.
- Growth hormone (GH) therapy is likely beneficial only for a minority of these children.
- Growth impairment in ALL survivors is multifactorial, not solely attributable to GH deficiency.
Abstract:
We have studied the relationship between abnormalities of the growth hormone-somatomedin axis and growth in 26 children previously treated for acute lymphatic leukemia. Each child had previously received cranial irradiation, was in complete clinical and hematologic remission, and off all drugs. The mean standing height SDS of the 26 children was significantly less than normal. There was no significant difference between the mean standing height SDS, height velocity SDS, somatomedin activities, and degree of bone age retardation between the 17 children who received the higher dose of cranial irradiation (Group 1) and the nine who had the lower dose of cranial irradiation (Group II). Furthermore, there was no significant reduction in mean height velocity SDS, somatomedin activity, or bone age in either group when compared to normal age-matched controls. The peak GH responses to both insulin hypoglycemia and an arginine test were significantly lowered in Groups I and II when compared to a control group of children. We conclude that only a minority of children, who previously received cranial irradiation for ALL were clinically GH deficient and, therefore, likely to benefit from GH therapy despite the finding that the majority of these children had reduced GH responses to pharmacologic stimuli.