High Prevalence of Early Endocrine Disorders After Childhood Brain Tumors in a Large Cohort

J Clin Endocrinol Metab. 2022 Apr 19;107(5):e2156-e2166. doi: 10.1210/clinem/dgab893.

Abstract

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.

Keywords: Brain tumor; childhood cancer; endocrine disorders; non-suprasellar; suprasellar.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brain Neoplasms* / epidemiology
  • Brain Neoplasms* / radiotherapy
  • Cerebellar Neoplasms* / complications
  • Cerebellar Neoplasms* / radiotherapy
  • Child
  • Endocrine System Diseases* / diagnosis
  • Endocrine System Diseases* / epidemiology
  • Endocrine System Diseases* / etiology
  • Female
  • Humans
  • Male
  • Pituitary Neoplasms* / complications
  • Pituitary Neoplasms* / epidemiology
  • Prevalence
  • Retrospective Studies

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