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Growth, growth hormone secretion and somatomedin C after cranial irradiation for acute lymphoblastic leukemia
Insights
Radiation therapy for acute lymphoblastic leukemia (ALL) frequently causes growth hormone (GH) deficiency. Careful monitoring of growth during puberty is crucial for patients treated for ALL.
Area of Science:
- Pediatric Endocrinology
- Radiation Oncology
- Hematology-Oncology
Background:
- Radiation therapy, particularly at doses of 2400 rad, is a common treatment for acute lymphoblastic leukemia (ALL).
- Growth hormone (GH) deficiency is a known potential side effect of radiation therapy in children.
- The long-term impact of GH dysregulation on pubertal growth in ALL survivors requires further investigation.
Purpose of the Study:
- To investigate the frequency of GH deficiency in patients treated for ALL.
- To correlate growth rates with GH status and insulin tolerance test (AITT) responses.
- To assess the relationship between plasma somatomedin C (SmC) levels and growth in these patients.
Main Methods:
- Retrospective analysis of 74 patients irradiated for ALL.
- Assessment of growth rates, GH deficiency via AITT, and plasma SmC levels.
- Documentation of prepubertal growth patterns and treatment with human GH (hGH).
Main Results:
- A high frequency (40%) of complete GH deficiency was observed in the patient cohort.
- Only 11 out of 46 prepubertal children experienced growth retardation; seven received hGH treatment.
- Eleven prepubertal cases exhibited normal growth despite impaired GH response to AITT, with plasma SmC values correlating with growth rates but sometimes showing discrepancies with AITT results.
Conclusions:
- A significant incidence of GH dysregulation occurs in patients treated for ALL.
- Growth patterns in prepubertal survivors can be complex, with some showing normal growth despite biochemical evidence of GH deficiency.
- Close monitoring of pubertal development and growth is essential in ALL survivors due to the high risk of GH-related issues.
Abstract:
In a large group of 74 patients irradiated with 2400 rad for acute lymphoblastic leukemia an unusually high frequency of complete GH deficiency was observed (40%). Only 11 out of 46 prepubertal children had growth retardation and seven children received hGH treatment. On the contrary 11 other prepubertal cases had normal growth rates in spite of lack of response to AITT. Plasma SmC values were correlated with growth rates but were discrepant with GH responses to AITT in some cases. Because of this high frequency of GH dysregulation further growth at time of puberty should be carefully documented.