Hypothalamic-pituitary dysfunction following CNS prophylaxis in acute lymphocytic leukemia: correlation with CT scan...

Area of Science:

• Pediatric Oncology
• Endocrinology
• Neurology

Background:

• Central nervous system (CNS) prophylaxis is crucial for treating acute lymphocytic leukemia (ALL).
• Potential adverse effects on hypothalamic-pituitary function require investigation.
• Cranial radiation and intrathecal chemotherapy are common CNS prophylaxis methods.

Purpose of the Study:

• To assess hypothalamic-pituitary function in pediatric ALL patients receiving CNS prophylaxis.
• To identify potential adverse effects of cranial radiation and intrathecal chemotherapy on growth hormone (GH) secretion.
• To explore the relationship between neuroimaging findings and endocrine dysfunction.

Main Methods:

• Evaluated hypothalamic-pituitary function in 23 patients with ALL.
• Assessed growth hormone response to insulin-induced hypoglycemia.
• Performed computed tomography (CT) brain scans to evaluate for ventricular dilatation.

Main Results:

• Nine out of 18 patients receiving both cranial radiation and intrathecal chemotherapy showed abnormally low growth hormone responses.
• Seven of these nine patients with low GH response also had ventricular dilatation on CT scans (P = 0.015).
• Patients without cranial radiation had normal GH responses and normal CT scans.

Conclusions:

• CNS prophylaxis, specifically cranial radiation and intrathecal chemotherapy, is associated with impaired growth hormone secretion.
• Ventricular dilatation on CT brain scans significantly correlates with diminished peak growth hormone responses.
• These findings highlight the need for monitoring endocrine function and neuroimaging changes in ALL survivors.