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Endocrine dysfunction and growth in children with medulloblastoma

Korean Journal of Pediatrics 2006;49(3):292-297.
Published online March 15, 2006.
Endocrine dysfunction and growth in children with medulloblastoma
In Suk Yoon, Ji Young Seo, Choong Ho Shin, Il Han Kim, Hee Young Shin, Sei Won Yang, Hyo Seop Ahn
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
소아 수모세포종 환자에서 치료 후의 내분비적 장애와 성장변화
윤인석, 서지영, 신충호, 김일환, 신희영, 양세원, 안효섭
서울대학교 의과대학 소아과학교실
Correspondence: 
Choong Ho Shin, Email: chshinpd@snu.ac.kr
Abstract
Purpose
: In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes.
Methods
: The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr.
Results
: The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from -0.1¡¾1.3 initially to -0.6¡¾1.0 after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency.
Conclusion
: Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.
Key Words: Medulloblastoma , Growth failure , Hypothyroidism , Hypogonadism , Radiation therapy


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