Abstract
Objective
To describe the endocrine follow-up of patients with primary brain tumors.
Methods
non interventional observational study, data collection from medical records of 221 patients followed at a Pediatric Endocrinology Department.
Results
48.9% were female, median age at diagnosis: 6.7 years (range: 0-15.9), median follow-up: 6.7 years (0.3-26.6). Main tumor types: medulloblastoma (37.6%), craniopharyngioma (29.0%) and glioma (20.4%). According to anatomical location, 48% were suprasellar (SS) and 52% non-suprasellar (NSS). GH deficiency (GHD) prevalence was similar in both groups (SS: 83.0%, NSS: 76.5%, p=0.338), appearing in median 1.8 years (-0.8 to 12.4) after diagnosis; post-radiotherapy GHD appeared in median 1.6 years after radiotherapy (0.2 to 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%). Hypogonatropic hypogonadism was predominant in SS (63.1%) vs NSS (1.3%), p<0.001, and post-chemotherapy 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), obesity incidence was higher for SS (46.2%) than NSS (17.4%).
Conclusions
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.