scholarly journals Declining free thyroxine levels over time in irradiated childhood brain tumor survivors

2018 ◽  
Vol 7 (12) ◽  
pp. 1322-1332 ◽  
Author(s):  
Laura van Iersel ◽  
Sarah C Clement ◽  
Antoinette Y N Schouten-van Meeteren ◽  
Annemieke M Boot ◽  
Hedi L Claahsen-van der Grinten ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Reference Range ◽  
Free Thyroxine ◽  
Reference Ranges ◽  
Childhood Brain Tumor ◽  
Cranial Radiotherapy ◽  
Central Hypothyroidism ◽  
Future Studies ◽  
Over Time

Objective The incidence of cranial radiotherapy (cRT)–induced central hypothyroidism (TSHD) in childhood brain tumor survivors (CBTS) is reported to be low. However, TSHD may be more frequent than currently suspected, as its diagnosis is challenging due to broad reference ranges for free thyroxine (FT4) concentrations. TSHD is more likely to be present when FT4 levels progressively decline over time. Therefore, we determined the incidence and latency time of TSHD and changes of FT4 levels over time in irradiated CBTS. Design Nationwide, 10-year retrospective study of irradiated CBTS. Methods TSHD was defined as ‘diagnosed’ when FT4 concentrations were below the reference range with low, normal or mildly elevated thyrotropin levels, and as ‘presumed’ when FT4 declined ≥ 20% within the reference range. Longitudinal FT4 concentrations over time were determined in growth hormone deficient (GHD) CBTS with and without diagnosed TSHD from cRT to last follow-up (paired t-test). Results Of 207 included CBTS, the 5-year cumulative incidence of diagnosed TSHD was 20.3%, which occurred in 50% (25/50) of CBTS with GHD by 3.4 years (range, 0.9–9.7) after cRT. Presumed TSHD was present in 20 additional CBTS. The median FT4 decline in GH-deficient CBTS was 41.3% (P < 0.01) to diagnosis of TSHD and 12.4% (P = 0.02) in GH-deficient CBTS without diagnosed TSHD. Conclusions FT4 concentrations in CBTS significantly decline over time after cRT, also in those not diagnosed with TSHD, suggesting that TSHD occurs more frequently and earlier than currently reported. The clinical relevance of cRT-induced FT4 decline over time should be investigated in future studies.

Effects of Age and Health on the Euthyroid Reference Ranges for Serum Free Thyroxine and Free Triiodothyronine

1985 ◽  
Vol 24 (02) ◽  
pp. 57-65 ◽  
Author(s):  
J. E. M. Midgley ◽  
K. R. Gruner
Keyword(s):  
Lower Limit ◽  
Healthy Subjects ◽  
Thyroid Dysfunction ◽  
Reference Range ◽  
Free Thyroxine ◽  
Reference Ranges ◽  
Free Triiodothyronine ◽  
Serum Free ◽  
Young Subjects ◽  
Age Range

SummaryAge-related trends in serum free thyroxine (FT4) and free triiodothyronine (FT3) concentrations were measured in 7248 euthyroid subjects (age-range 3 months to 106 years). 5700 were patients referred to hospitals for investigation of suspected thyroid dysfunction, but who were diagnosed euthyroid. 1548 were healthy blood donors (age-range 18-63 years) with no indication of thyroid dysfunction. FT4 concentrations were little affected by the age, the sex or the state of health of the subjects in either group. Serum FT3 concentrations were significantly affected by both age and health factors. The upper limit of the euthyroid reference range for young subjects up to 15 years was about 20% higher (10.4 pmol/1) than for adult subjects older than 25 years (8.8 pmol/1). The change in the upper limits typical of young subjects to that typical of adults occurred steadily over the decade 15–25 years. After this age, little further change occurred, especially in healthy subjects. Additionally, the lower limit of the euthyroid range for FT3 was extended by the inclusion in the reference group of patients referred to hospitals. Compared with the lower limit of the FT3 range for healthy subjects (5 pmol/1), the corresponding limit for referred subjects (young or adult) was 3.5–3.8 pmol/1. Broadening of the FT3 reference range was probably brought about by a significant number of patients in the hospital-referred group with the “1OW-T3 syndrome” of mild non-thyroidal illness. Accordingly, FT3 was inferior to FT4 in the discrimination of hypothyroidism, as FT4 was unaffected by this phenomenon. Effects of age and non-thyroidal illness on serum FT3 concentrations require great care when selecting subjects for a laboratory euthyroid reference range typical of the routine workload. Constraints on the choice of subjects for FT4 reference ranges are less stringent.

scholarly journals High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction

2021 ◽  
pp. JCO.20.01765
Author(s):  
Jiska van Schaik ◽  
Ichelle M. A. A. van Roessel ◽  
Netteke A. Y. N. Schouten-van Meeteren ◽  
Laura van Iersel ◽  
Sarah C. Clement ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Weight Gain ◽  
Standard Deviation Score ◽  
Cardiometabolic Health ◽  
Low Grade ◽  
Childhood Brain Tumor ◽  
Significant Weight Gain ◽  
Overweight Or Obesity

PURPOSE Childhood brain tumor survivors (CBTS) are at risk for developing obesity, which negatively influences cardiometabolic health. The prevalence of obesity in CBTS may have been overestimated in previous cohorts because of inclusion of children with craniopharyngioma. On the contrary, the degree of weight gain may have been underestimated because of exclusion of CBTS who experienced weight gain, but were neither overweight nor obese. Weight gain may be an indicator of underlying hypothalamic-pituitary (HP) dysfunction. We aimed to study prevalence of and risk factors for significant weight gain, overweight, or obesity, and its association with HP dysfunction in a national cohort of noncraniopharyngioma and nonpituitary CBTS. METHODS Prevalence of and risk factors for significant weight gain (body mass index [BMI] change ≥ +2.0 standard deviation score [SDS]), overweight, or obesity at follow-up, and its association with HP dysfunction were studied in a nationwide cohort of CBTS, diagnosed in a 10-year period (2002-2012), excluding all craniopharyngioma and pituitary tumors. RESULTS Of 661 CBTS, with a median age at follow-up of 7.3 years, 33.1% had significant weight gain, overweight, or obesity. Of the CBTS between 4 and 20 years of age, 28.7% were overweight or obese, compared with 13.2% of the general population between 4 and 20 years of age. BMI SDS at diagnosis, diagnosis of low-grade glioma, diabetes insipidus, and central precocious puberty were associated with weight gain, overweight, or obesity. The prevalence of HP dysfunction was higher in overweight and obese CTBS compared with normal-weight CBTS. CONCLUSION Overweight, obesity, and significant weight gain are prevalent in CBTS. An increase in BMI during follow-up may be a reflection of HP dysfunction, necessitating more intense endocrine surveillance.

NCOG-48. LONGITUDINAL ASSESSMENT OF SUBJECTIVE COGNITIVE FUNCTION IN A BRAIN TUMOR SAMPLE: IMPROVED CORRESPONDENCE WITH NEUROPSYCHOLOGICAL PERFORMANCE OVER TIME

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi162-vi162
Author(s):  
Melissa Gardner ◽  
Giuliana Zarrella ◽  
Jorg Dietrich ◽  
Michael Parsons
Keyword(s):  
Brain Tumor ◽  
Cognitive Function ◽  
Neuropsychological Test ◽  
Initial Evaluation ◽  
Longitudinal Assessment ◽  
Change Scores ◽  
Subjective Cognitive Function ◽  
Neuropsychological Evaluations ◽  
Over Time

Abstract INTRODUCTION Estimates of subjective cognitive function (SCF) generally show minimal correlation with objective measures of neurocognitive function (NCF). Our group recently validated a new metric of SCF in neuro-oncology patients, creating the Cognitive Index of the Functional Assessment of Cancer Therapy-Brain (FACT-Br-CI). This study examines whether brain tumor (BT) patients evaluated on more than one occasion show improved relationship between SCF and NCF. We hypothesized that change scores in SCF and NCF across evaluation would be more highly correlated than SCF and NCF at either timepoint. METHODS A retrospective study of BT patients who completed two neuropsychological evaluations (baseline, follow-up) was conducted. NCF was measured by the clinical trial battery composite (CTBC), a mean of 6 commonly used neuropsychological test scores. SCF was measured by the FACT-Br-CI. Mood/Anxiety were measured by the Beck scales (BAI/BDI-II). Change over time on each metric was evaluated with paired t-test. Correlational analyses evaluated relationships between NCF, SCF, and mood within and between time points. RESULTS Twenty-nine patients (16 female; mean age=54.6y; mean education=15.5y) completed all CTBC measures and FACT-Br-CI, 28 of whom completed and BDI and/or BAI. On group analyses, there were no significant differences between baseline and follow-up on CTBC (t=-.53;p=ns) or FACT-Br-CI (t=-.98;p=ns). Correlations between CTBC and FACT-Br-CI were nonsignificant at baseline (r=.24;p=ns), but significant at follow-up (r=.56;p=0.002). Change scores over time were unrelated (r=-.104;p=ns). Similar to previous studies, the FACT-BR-CI correlated with the BDI-II at baseline (r=-.38;p=0.04) and follow-up (r=-.59;p&lt; 0.001) and with the BAI at follow-up (r=-.44;p=0.02). CONCLUSION In this small group of brain tumor patients seen for repeated neuropsychological evaluations, we found that agreement between SCF and NCF was much higher on their second than initial evaluation. These findings suggest that patients may develop enhanced awareness of their cognitive function from an initial evaluation that persists over time.

scholarly journals Changes of trace element status during aging: results of the EPIC-Potsdam cohort study

2019 ◽  
Vol 59 (7) ◽  
pp. 3045-3058 ◽  
Author(s):  
Julia Baudry ◽  
Johannes F. Kopp ◽  
Heiner Boeing ◽  
Anna P. Kipp ◽  
Tanja Schwerdtle ◽  
...  
Keyword(s):  
Reference Ranges ◽  
Linear Regression Models ◽  
Serum Samples ◽  
Time Points ◽  
Supplement Use ◽  
Healthy Elderly ◽  
Age Related ◽  
Longitudinal Variability ◽  
Over Time

Abstract Purpose We aimed to evaluate age-dependent changes of six trace elements (TE) [manganese (Mn), iron (Fe), zinc (Zn), copper (Cu), iodine (I), and selenium (Se)] over a 20-year period. Methods TE concentrations were determined using repeated serum samples taken at baseline and after 20 years of follow-up from 219 healthy participants of the EPIC-Potsdam study, using inductively coupled plasma tandem mass spectrometry. For each TE, absolute and relative differences were calculated between the two time points, as well as the proportion of individuals within normal reference ranges. Interdependence between age-related TE differences was investigated using principal component analysis (PCA). Relationships between selected factors (lifestyle, sociodemographic, anthropometric factors, and hypertension) and corresponding TE longitudinal variability were examined using multivariable linear regression models. Results Median age of our study sample was 58.32 years (4.42) at baseline and 40% were females. Median Mn, Zn, Se concentrations and Se to Cu ratio significantly decreased during aging while median Fe, Cu, I concentrations and Cu to Zn ratio significantly increased. A substantial percentage of the participants, at both time points, had Zn concentrations below the reference range. The first PCA-extracted factor reflected the correlated decline in both Mn and Zn over time while the second factor reflected the observed (on average) increase in both Cu and I over time. Overall, none of the investigated factors were strong determinants of TE longitudinal variability, except possibly dietary supplement use, and alcohol use for Fe. Conclusions In conclusion, in this population-based study of healthy elderly, decrease in Mn, Zn, and Se concentrations and increase in Fe, Cu, and I concentrations were observed over 20 years of follow-up. Further research is required to investigate dietary determinants and markers of TE status as well as the relationships between TE profiles and the risk of age-related diseases.

scholarly journals 24 Radiation induced meningioma in adult survivors of childhood leukemia or primary brain tumor treated with cranial radiotherapy: Incidence and screening recommendations

2018 ◽  
Vol 45 (S3) ◽  
pp. S5-S5
Author(s):  
Maryam Dosani ◽  
Jordan Tran ◽  
Jessica L Conway ◽  
Karen Goddard
Keyword(s):  
Brain Tumor ◽  
Childhood Leukemia ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Adult Survivors ◽  
Steady Increase ◽  
Cranial Radiotherapy ◽  
Radiation Induced ◽  
Age Range

Purpose: Cranial radiotherapy (CRT) was commonly given for childhood leukemia and brain tumors. Survivors are at risk of late effects including radiation induced meningioma (RIM). Surveillance for RIM is not standardized . We aimed to determine the incidence, latency, and screening patterns for RIM. Materials and Methods: Retrospective chart review of all patients aged <18 years at the time of radiation (RT), treated with CRT for leukemia or a brain tumor in BC between 1981-2006. Patient, tumor, and treatment characteristics were collected. Actuarial statistics were calculated with Kaplan-Meier Curves. Patients were censored at the date of last normal cranial imaging, or development of a RIM. Results: 392 patients were identified. Median age (range) at CRT was 9.6 years. Median CRT dose was 28Gy. The original diagnosis was leukemia in 50%, glioma in 13%, medulloblastoma in 8%, ependymoma in 7%, neuroectodermal tumor in 7%, germ cell tumor in 5%, craniopharyngioma in 4%, and other pathologies in 6%. Median (range) of clinical follow-up (FU) was 13.2 (0-37.5) years. Median (range) of cranial imaging FU was 15.5 (0-21.2) years. There was no documented cranial imaging FU in 144 patients. Forty-eight patients developed a RIM. The median age (range) at RT for patients with RIM was 6.7 years. Only 8 of these cases presented with associated symptoms. The earliest RIM in our cohort occurred 10.2 years after CRT. On actuarial analysis, the median (95% CI) time to development of a meningioma was 29.8 (28.9-30.7) years. Incidence (95% CI) of meningioma at 10 years was 0%, 15 years was 5 (2-9)%, 20 years was 12 (6-18)%, 25 years was 33 (23-43)% and 30 years was 47 (37-68)%. Amongst patients with a RIM, the median dose of CRT was 45 Gy. The lowest dose of RT in a patient who developed RIM was 12 Gy. RT was delivered to the whole brain in 58% and partial brain in 42% of patients with a RIM. Conclusions: After CRT in pediatric patients, there is a significant risk of developing a RIM and a steady increase in this risk with ongoing follow-up. We recommend standardization of surveillance for these patients with screening beginning 10 years after completion of CRT.

Prevalence and Risk Factors of Early Endocrine Disorders in Childhood Brain Tumor Survivors: A Nationwide, Multicenter Study

2016 ◽  
Vol 34 (36) ◽  
pp. 4362-4370 ◽  
Author(s):  
Sarah C. Clement ◽  
Antoinette Y.N. Schouten-van Meeteren ◽  
Annemieke M. Boot ◽  
Hedy L. Claahsen-van der Grinten ◽  
Bernd Granzen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Function ◽  
Hormone Deficiency ◽  
Study Cohort ◽  
Endocrine Disorders ◽  
Childhood Brain Tumor ◽  
Endocrine Disorder

Purpose To evaluate the prevalence of, and risk factors for, early endocrine disorders in childhood brain tumor survivors (CBTS). Patients and Methods This nationwide study cohort consisted of 718 CBTS who were diagnosed between 2002 and 2012, and who survived ≥ 2 years after diagnosis. Patients with craniopharyngeoma or a pituitary gland tumor were excluded. Results of all endocrine investigations, which were performed at diagnosis and during follow-up, were collected from patient charts. Multivariable logistic regression was used to study associations between demographic and tumor- and treatment-related variables and the prevalence of early endocrine disorders. Results After a median follow-up of 6.6 years, 178 CBTS (24.8%) were diagnosed with an endocrine disorder. A total of 159 CBTS (22.1%) presented with at least one endocrine disorder within the first 5 years after diagnosis. The most common endocrine disorders were growth hormone deficiency (12.5%), precocious puberty (12.2%), thyroid-stimulating hormone deficiency (9.2%), and thyroidal hypothyroidism (5.8%). The risk of hypothalamic-pituitary dysfunction (n = 138) was associated with radiotherapy (odds ratio [OR], 15.74; 95% CI, 8.72 to 28.42), younger age at diagnosis (OR, 1.09; 95% CI, 1.04 to 1.14), advanced follow-up time (OR, 1.10; 95% CI, 1.02 to 1.18), hydrocephalus at diagnosis (OR, 1.77; 95% CI, 1.09 to 2.88), and suprasellar (OR, 34.18; 95% CI, 14.74 to 79.29) and infratentorial (OR, 2.65; 95% CI, 1.48 to 4.74) tumor site. Conclusion The prevalence of early endocrine disorders among CBTS is high. The observation that 22.1% of CBTS developed at least one endocrine disorder within the first 5 years after diagnosis stresses the importance of early and regular assessment of endocrine function in CBTS who are at risk for endocrine damage.

Prevalence of endocrine disorders in childhood brain tumor survivors in South Korea: A nationwide population-based, longitudinal study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e21517-e21517
Author(s):  
Jaesung Heo ◽  
O Kyu Noh ◽  
Jun Eun Park ◽  
Minhyung Cho ◽  
Seonghye Choi
Keyword(s):  
Brain Tumor ◽  
Longitudinal Study ◽  
South Korea ◽  
Odds Ratio ◽  
Treatment Compliance ◽  
Endocrine Function ◽  
Hormone Deficiency ◽  
Endocrine Disorders ◽  
Childhood Brain Tumor

e21517 Background: Brain tumors are the most common solid cancers in child patients with a current expected 5-year overall survival rate of 73%. Also, patients with brain cancer tend to have a high rate of neuroendocrine disorders. These endocrine problems may have a significant negative effect on quality of life and treatment compliance. Methods: The aim of this longitudinal study was to analyze the prevalence of endocrine disorders in childhood brain tumor survivors using claims data in South Korea. We confirmed endocrine disorders in a nationwide cohort of 1,058 patients who were diagnosed with brain tumor between January 1, 2009 and March 29, 2016 and who survived > 2 years after diagnosis. Multivariable logistic regression was used to evaluate association between demographic and treatment related variables and the prevalence of endocrine disorders. Results: After a median follow-up of 60.0 months, a total of 393 (37.1%) patients were diagnosed with at least one endocrine disorder. The median follow-up time from primary brain tumor diagnosis to diagnosis of first endocrine disorders was 26.3 months (range, 0.06 to 96.7). Of those patients, 333 childhood brain tumor survivors were diagnosed with endocrine disorders during their first 5 years after diagnosis. The overall frequency of endocrine disorders peaked during 2 months after the cancer diagnosis. The most common endocrine disorders were pituitary dysfunction (21.9%), thyroidal disease (6.1%), precocious puberty (4.6%), and growth hormone deficiency (4.3%). Female patients were at a higher risk for endocrine disorders (odds ratio: 1.45, p = 0.005). The patients with radiotherapy were more likely to have endocrine disorders compared without radiotherapy (odds ratio: 1.79, p < 0.001). Conclusions: Endocrine disorders in childhood brain tumor survivors was high and showed different patterns of prevalence depending on the nature of disease and time sequence. In childhood brain tumor survivors who are risk of endocrine disorders, regular assessment of endocrine function and timely intervention were needed. [Table: see text]

Prevalence and Risk Factors of Hypothalamic-Pituitary Dysfunction in Infant and Toddler Childhood Brain Tumor Survivors

2021 ◽  
Author(s):  
C A Lebbink ◽  
T.p Ringers ◽  
A.y.n. Schouten-van Meeteren ◽  
L van Iersel ◽  
S.c Clement ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Age Groups ◽  
Tumor Location ◽  
Childhood Brain Tumor ◽  
Older Children ◽  
Treatment Protocols ◽  
Pituitary Dysfunction ◽  
Frequent Use

Objective Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic-pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0-1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1-3 years) have not been performed. Patients and Methods A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler- and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n=460). Results In total 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite less frequent use of radiotherapy (RT) in infants, no differences in prevalence of HPD were found between the three groups. RT (OR 16.44; 95%CI 8.93 to 30.27), suprasellar tumor location (OR 44.76; 95%CI 19.00 to 105.49) and younger age (OR 1.11; 95%CI 1.05 to 1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (p<0.0001) and smaller height SDS (p=0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH- and ADH deficiency, compared to older-BTS. Conclusion Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant- and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at young age.

scholarly journals QOS-05AN ITALIAN NETWORK FOR THE NEUROCOGNITIVE AND PSYCHOLOGICAL FOLLOW-UP OF CHILDHOOD BRAIN TUMOR SURVIVORS

2016 ◽  
Vol 18 (suppl 3) ◽  
pp. iii146.1-iii146
Author(s):  
Geraldina Poggi ◽  
Marina Bertolotti ◽  
Claudia Corti ◽  
Simona Bellini ◽  
Daniele Bertin ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Childhood Brain Tumor

scholarly journals Prevalence and Risk Factors of Hypothalamic-Pituitary Dysfunction in Infant and Toddler Brain Tumor Survivors

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A719-A719
Author(s):  
Chantal A Lebbink ◽  
Tiara P Ringers ◽  
Antoinette Y N Schouten-van Meeteren ◽  
Laura van Iersel ◽  
Sarah C Clement ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Age Groups ◽  
Tumor Location ◽  
Childhood Brain Tumor ◽  
Older Children ◽  
Treatment Protocols ◽  
Pituitary Dysfunction ◽  
Oncologic Treatment

Abstract Background: Childhood brain tumor survivors (CBTS) are at risk for hypothalamic-pituitary (HP) dysfunction, mainly caused by radiation exposure or tumor involvement of the HP-region. The risk for HP dysfunction (HPD) may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. The aim of this study was to determine the prevalence and risk factors of HPD in infant (IBTS) and toddler brain tumor survivors (TBTS) compared to older childhood brain tumor survivors (OCBTS). Patients and Methods: A retrospective analysis in a nationwide cohort of CBTS was performed. Prevalence and risk factors for HPD were compared between IBTS (aged 0-1 years at diagnosis), TBTS (aged 1-3 years at diagnosis) and OCBTS (aged &gt;3-18 years at diagnosis). Results: In 718 included CBTS, with a median follow-up time of 7.9 years, overall no differences in percentage of HPD were found between the three age groups. Treatment with radiotherapy (RT) (OR 15.41; 95%CI 8.33 to 28.48), suprasellar tumor location (OR 46.62; 95%CI 19.64 to 110.66) and younger age (OR 1.09; 95%CI 1.02 to 1.15) were associated with HP dysfunction. Because IBTS were significantly less often treated with RT, subanalyses were performed for all CBTS not treated with radiation (n=459). In non-irradiated CBTS, IBTS and TBTS were significantly more frequently diagnosed with TSH-, ACTH- and ADH deficiency, compared to ECBTS. IBTS and TBTS showed significantly more weight gain (p&lt;0.0001) and smaller height SDS (p=0.001) during follow-up. Conclusion: Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than when compared to older children. These results emphasize the importance of special infant and toddlers brain tumor treatment protocols and endocrine surveillance in children treated for a brain tumor at young age.

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