Early Metabolic Risk in Childhood Brain Cancer Survivors With Childhood-Onset Growth Hormone Deficiency

Growth hormone deficiency (GHD) is the earliest and most common pituitary-hormone deficiency in childhood brain cancer (CBC) survivors. To evaluate metabolic and endocrine outcomes in survivors of CBC (excluding craniopharyngiomas) who received growth hormone therapy during childhood, following their transition into adulthood.

Observational, multicentric study across 1 pediatric endocrinology, 2 pediatric oncology departments, and 1 adult endocrinology department. Ninety-one CBC survivors with childhood-onset GHD, aged ≥18 years in January 2025, with follow-up data available through April 30, 2025, were included. Assessments included lipid profile, HbA1c, bone mineral density (BMD), body mass index, and pituitary hormone status. Subgroup analyses compared patients with suprasellar versus non-suprasellar tumors and those with persistent adulthood GHD with or without continued GH therapy versus transient GHD. Multivariate analyses were performed.

Median age at last evaluation was 21 years (IQR 19-26). At transition, 71/91 patients (78%) remained GHD. Dyslipidemia affected 54/91 (59.4%) individuals, prediabetes 9/91 (10%), and reduced BMD (osteopenia or osteoporosis) 62/90 (68.6%). Body mass index and HbA1C were significantly higher in the suprasellar subgroup than the non-suprasellar subgroup. Dyslipidemia was not associated with tumor location. No significant differences among patients with persistent GHD on GH therapy, persistent GHD without therapy, or transient GHD.

Among CBC survivors with childhood-onset GHD, dyslipidemia, impaired glucose metabolism, and reduced BMD are highly prevalent in very early adulthood. Suprasellar tumors show a distinct metabolic vulnerability.