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Cranial irradiation and early puberty

A L Ogilvy-Stuart1, P E Clayton, S M Shalet

  • 1Department of Endocrinology, Christie Hospital, Manchester, United Kingdom.

The Journal of Clinical Endocrinology and Metabolism
|June 1, 1994
PubMed
Summary

Higher dose cranial irradiation for brain tumors causes early puberty in both boys and girls, not just girls. This early onset of puberty in children with growth hormone deficiency is abnormal and impacts treatment duration.

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Area of Science:

  • Pediatric Endocrinology
  • Radiation Oncology
  • Neuro-oncology

Background:

  • Low-dose cranial irradiation for acute lymphoblastic leukemia can cause precocious puberty, primarily in girls.
  • The effect of higher irradiation doses on pubertal onset in children treated for brain tumors is less understood.
  • Growth hormone (GH) deficiency, often a consequence of such treatments, typically delays puberty.

Purpose of the Study:

  • To investigate if higher doses of cranial irradiation (25-47 gray) lead to early puberty in both sexes.
  • To determine the relationship between age at irradiation and the onset of puberty in GH-deficient children.
  • To assess if radiation-induced early puberty occurs in children treated for brain tumors.

Main Methods:

  • Studied 46 GH-deficient children (30 males) previously treated with cranial irradiation for brain tumors.
  • Assessed the onset of puberty by comparing patient data with normal pubertal standards (Marshall and Tanner).
  • Analyzed the association between age at irradiation and age at pubertal onset, considering bone age.

Main Results:

  • Significant linear association found between age at irradiation and age of pubertal onset in both sexes.
  • Early onset of puberty observed in both boys (mean 9.21 years) and girls (mean 8.51 years), influenced by age at irradiation.
  • Early bone age development noted, with onset occurring approximately 0.7 years earlier in girls than boys at comparable irradiation ages.
  • Radiation-induced early puberty is not limited to girls at these higher doses.

Conclusions:

  • Higher dose cranial irradiation for brain tumors can induce early puberty in both male and female children.
  • This phenomenon is abnormal in the context of GH deficiency, where delayed puberty is typically expected.
  • Early puberty may shorten the therapeutic window for growth hormone treatment in children with radiation-induced GH deficiency.

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