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High Prevalence of Early Endocrine Disorders After Childhood Brain Tumors in a Large Cohort
Laura Gabriela González Briceño1,2, Dulanjalee Kariyawasam1, Dinane Samara-Boustani1
1Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France.
Insights
Pediatric brain tumor patients frequently develop endocrine complications, including growth hormone deficiency and hypothyroidism, particularly those with suprasellar tumors. Early endocrine consultation is crucial for managing these common disorders.
Area of Science:
- Pediatric Endocrinology
- Neuro-oncology
- Endocrinology
Background:
- Endocrine complications are a significant concern for children diagnosed with primary brain tumors.
- Long-term follow-up is essential to monitor and manage these potential sequelae.
Purpose of the Study:
- To characterize the endocrine follow-up and complications in a cohort of pediatric patients with primary brain tumors.
- To compare endocrine outcomes based on tumor location, specifically suprasellar versus non-suprasellar.
Main Methods:
- A noninterventional observational study involving 221 pediatric patients with primary brain tumors.
- Data were collected retrospectively from medical records at a Pediatric Endocrinology Department.
- Analysis included tumor type, location, treatments, and various endocrine function tests and anthropometric measurements.
Main Results:
- High prevalence of growth hormone deficiency (GHD), hypothyroidism, ACTH deficiency, and hypogonadotropic hypogonadism, particularly in suprasellar (SS) tumors.
- Non-suprasellar (NSS) tumors were associated with lower adult height and higher post-chemotherapy gonadal toxicity.
- Increased BMI and obesity incidence were observed in both SS and NSS groups post-treatment. Thyroid nodules and cancers were noted following radiotherapy.
Conclusions:
- Pediatric brain tumor patients experience a high incidence of early-onset endocrine disorders.
- Routine endocrine assessment and nutritional evaluation are recommended for all brain tumor patients, especially those with suprasellar tumors or after hypothalamus/pituitary irradiation.
Context:
Endocrine complications are common in pediatric brain tumor patients.
Objective:
We aimed to describe the endocrine follow-up of patients with primary brain tumors.
Methods:
This is a noninterventional observational study based on data collection from medical records of 221 patients followed at a Pediatric Endocrinology Department.
Results:
Median age at diagnosis was 6.7 years (range, 0-15.9), median follow-up 6.7 years (0.3-26.6), 48.9% female. Main tumor types were medulloblastoma (37.6%), craniopharyngioma (29.0%), and glioma (20.4%). By anatomic location, 48% were suprasellar (SS) and 52% non-suprasellar (NSS). Growth hormone deficiency (GHD) prevalence was similar in both groups (SS: 83.0%, NSS: 76.5%; P = 0.338), appearing at median 1.8 years (-0.8 to 12.4) after diagnosis; postradiotherapy GHD appeared median 1.6 years after radiotherapy (0.2-10.7). Hypothyroidism was more prevalent in SS (76.4%), than NSS (33.9%) (P < 0.001), as well as ACTH deficiency (SS: 69.8%, NSS: 6.1%; P < 0.001). Early puberty was similar in SS (16%) and NSS (12.2%). Hypogonadotropic hypogonadism was predominant in SS (63.1%) vs NSS (1.3%), P < 0.001, and postchemotherapy gonadal toxicity in NSS (29.6%) vs SS (2.8%), P < 0.001. Adult height was lower for NSS compared to target height (-1.0 SD, P < 0.0001) and to SS patients (P < 0.0001). Thyroid nodules were found in 13/45 patients (28.8%), including 4 cancers (4.8-11.5 years after radiotherapy). Last follow-up visit BMI was higher in both groups (P = 0.0001), and obesity incidence was higher for SS (46.2%) than NSS (17.4%).
Conclusion:
We found a high incidence of early-onset endocrine disorders. An endocrine consultation and nutritional evaluation should be mandatory for all patients with a brain tumor, especially when the tumor is suprasellar or after hypothalamus/pituitary irradiation.
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