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Jin HY, Lee JA, Park M, Park HJ. Prevalence and Risk Factors of Metabolic Syndrome Components in Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2022; 12:224-231. [PMID: 35788148 DOI: 10.1089/jayao.2021.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: It is crucial for childhood cancer survivors (CCSs) to manage metabolic syndrome. The prevalence and predictive factors of metabolic syndrome components in CCSs were investigated. Methods: This study included CCSs who were diagnosed with cancer under the age of 20 and completed therapy more than 1 year ago. The anthropometric and laboratory data were obtained from the medical records retrospectively. The reference group was extracted from the Korea National Health and Nutrition Examination Survey (2016-2019). Results: Of the participants, 29.1% (75 of 258) of the CCSs and 26.4% (1339 of 5081) of the reference group were obese. Blood pressure and triglyceride levels were significantly different in the two groups. Metabolic syndrome was identified in 35 of 258 (13.6%) patients. The reference group showed a 9.4% of prevalence (480 of 5086) (p = 0.028). A total of 127 of 230 (59.6%) met at least one of the dyslipidemia criteria. In multivariate analysis, current age and growth hormone deficiency (GHD) (OR = 5.905) were significant prognostic factors for dyslipidemia, and GHD was a significant prognostic factor for hypertriglyceridemia (OR = 2.864, p = 0.0316) and hypercholesterolemia (OR = 3.053, p = 0.0467). Cranial radiotherapy (RT) was a prognostic variable for hyper low-density lipoprotein cholesterolemia (OR = 2.866, p = 0.0032). Conclusions: The frequency of metabolic syndrome was higher in CCSs compared with the reference group. Dyslipidemia was common in CCSs with clinical parameters such as GHD and cranial RT. Risk-based long-term follow-up is needed, and early intervention is required for CCSs.
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Affiliation(s)
- Hye Young Jin
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
| | - Jun Ah Lee
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
| | - Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
| | - Hyeon Jin Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center Hospital, Goyang-si, Republic of Korea
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2
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Lone DW, Sadak KT, Miller BS, Sample JM, Hubbard AK, Wolter C, Roesler M, Nuno M, Poynter JN. Growth Hormone Deficiency in Childhood Intracranial Germ Cell Tumor Survivors. JOURNAL OF ENDOCRINOLOGY AND METABOLISM 2022; 12:79-88. [PMID: 36249955 PMCID: PMC9555288 DOI: 10.14740/jem807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND AIMS Intracranial germ cell tumor (iGCT) survivors have multiple risk factors for growth hormone (GH) deficiency, a commonly reported late effect in childhood cancer survivors. The objective of this study is to examine the prevalence of GH deficiency among childhood iGCT survivors. METHODS Participants were previously enrolled in the Germ Cell Tumor Epidemiology Study (GaMETES), a case parent triad study conducted using the Children's Oncology Group registry protocols, including 216 cases with iGCTs. Data on late effects and outcomes are available for 129 iGCT cases who consented for a follow-up study including a self-administered questionnaire and medical record retrieval. GH deficiency was identified via self-report and validated through medical record review. Chi-squared and Fisher's exact tests were used to examine cases with GH deficiency predating iGCT detection. Logistic regression was used to identify predictors of GH deficiency as a late effect. RESULTS Of 129 iGCT cases who participated in the late effects study, 45% had GH deficiency; 18% had GH deficiency predating the iGCT and 27% developed GH deficiency within a median of 19 months after diagnosis. Younger age at diagnosis, suprasellar location, and higher radiation doses were associated with GH deficiency as a late effect. CONCLUSIONS GH deficiency is highly prevalent as an early clinical sign for iGCT and frequently arises as an early late effect after treatment. Additional investigation is needed to address earlier detection and treatment for this highly prevalent late effect in iGCT survivors.
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Affiliation(s)
- Diana W Lone
- Department of Pediatrics, University of Minnesota, MN 55455, USA
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Bayless Cancer Institute, St. Joseph’s Children’s Hospital, Tampa, FL 33607, USA
| | - Karim T Sadak
- Department of Pediatrics, University of Minnesota, MN 55455, USA
- Masonic Cancer Center, University of Minnesota, MN 55455, USA
| | - Bradley S Miller
- Department of Pediatrics, University of Minnesota, MN 55455, USA
- Masonic Cancer Center, University of Minnesota, MN 55455, USA
| | - Jeannette M Sample
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aubrey K Hubbard
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caryn Wolter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Michelle Nuno
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Children’s Oncology Group, Monrovia, CA, USA
| | - Jenny N Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, MN 55455, USA
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3
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Boguszewski MCS, Boguszewski CL, Chemaililly W, Cohen LE, Gebauer J, Higham C, Hoffman AR, Polak M, Yuen KCJ, Alos N, Antal Z, Bidlingmaier M, Biller BMK, Brabant G, Choong CSY, Cianfarani S, Clayton PE, Coutant R, Cardoso-Demartini AA, Fernandez A, Grimberg A, Guðmundsson K, Guevara-Aguirre J, Ho KKY, Horikawa R, Isidori AM, Jørgensen JOL, Kamenicky P, Karavitaki N, Kopchick JJ, Lodish M, Luo X, McCormack AI, Meacham L, Melmed S, Mostoufi Moab S, Müller HL, Neggers SJCMM, Aguiar Oliveira MH, Ozono K, Pennisi PA, Popovic V, Radovick S, Savendahl L, Touraine P, van Santen HM, Johannsson G. Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement. Eur J Endocrinol 2022; 186:P35-P52. [PMID: 35319491 PMCID: PMC9066587 DOI: 10.1530/eje-21-1186] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/23/2022] [Indexed: 12/02/2022]
Abstract
Growth hormone (GH) has been used for over 35 years, and its safety and efficacy has been studied extensively. Experimental studies showing the permissive role of GH/insulin-like growth factor 1 (IGF-I) in carcinogenesis have raised concerns regarding the safety of GH replacement in children and adults who have received treatment for cancer and those with intracranial and pituitary tumours. A consensus statement was produced to guide decision-making on GH replacement in children and adult survivors of cancer, in those treated for intracranial and pituitary tumours and in patients with increased cancer risk. With the support of the European Society of Endocrinology, the Growth Hormone Research Society convened a Workshop, where 55 international key opinion leaders representing 10 professional societies were invited to participate. This consensus statement utilized: (1) a critical review paper produced before the Workshop, (2) five plenary talks, (3) evidence-based comments from four breakout groups, and (4) discussions during report-back sessions. Current evidence reviewed from the proceedings from the Workshop does not support an association between GH replacement and primary tumour or cancer recurrence. The effect of GH replacement on secondary neoplasia risk is minor compared to host- and tumour treatment-related factors. There is no evidence for an association between GH replacement and increased mortality from cancer amongst GH-deficient childhood cancer survivors. Patients with pituitary tumour or craniopharyngioma remnants receiving GH replacement do not need to be treated or monitored differently than those not receiving GH. GH replacement might be considered in GH-deficient adult cancer survivors in remission after careful individual risk/benefit analysis. In children with cancer predisposition syndromes, GH treatment is generally contraindicated but may be considered cautiously in select patients.
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Affiliation(s)
| | - Cesar L Boguszewski
- SEMPR (Endocrine Division), Department of Internal Medicine, Federal University of Parana, Curitiba, Brazil
| | - Wassim Chemaililly
- Division of Endocrinology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laurie E Cohen
- Division of Endocrinology and Diabetes, Department of Pediatrics, The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York, USA
| | - Judith Gebauer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Claire Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew R Hoffman
- Stanford University School of Medicine, Stanford, California, USA
| | - Michel Polak
- Department of Pediatric Endocrinology, Gynecology and Diabetology, Hôpital Universitaire Necker Enfants Malades, AP-HP, Université de Paris, Paris, France
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, Phoenix, Arizona, USA
- Department of Neuroendocrinology, St. Joseph’s Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
| | - Nathalie Alos
- Division of Endocrinology, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Zoltan Antal
- Memorial Sloan-Kettering Cancer Center and Weill Cornel Medicine New York Presbyterian Hospital, New York, New York, USA
| | | | - Beverley M K Biller
- Neuroendocrine & Pituitary Tumor Clinical Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George Brabant
- Department of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Catherine S Y Choong
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Child & Adolescent Health Service, Perth, Australia
- Division of Paediatrics, Faculty of Health & Medical Sciences, University of Western Australia, Perth, Australia
| | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome Italy
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS ‘Bambino Gesu’ Children’s Hospital, Rome Italy
- Department of Women’s and Children’s Health, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Peter E Clayton
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Regis Coutant
- Department of Pediatric Endocrinology, University Hospital, Angers, France
| | - Adriane A Cardoso-Demartini
- Pediatric Endocrinology Unit, Department of Pediatrics, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
| | - Alberto Fernandez
- Endocrinology Department, Hospital Universitario de Mostoles, Mostoles, Spain
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kolbeinn Guðmundsson
- Children’s Medical Center, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jaime Guevara-Aguirre
- Department of Diabetes and Endocrinology, College of Medicine, Universidad San Francisco de Quito at Quito, Quito, Ecuador
| | - Ken K Y Ho
- The Garvan Institute of Medical Research and St. Vincent Hospital, Sydney, Australia
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy
| | | | - Peter Kamenicky
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to N Karavitaki;
| | - John J Kopchick
- Edison Biotechnology Institute and Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Maya Lodish
- Division of Pediatric Endocrinology and Diabetes, University of California, San Francisco, California, USA
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tonji Medical College, Hu, China
| | - Ann I McCormack
- Department of Endocrinology, St Vincent’s Hospital, Sydney, Australia
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia
- St Vincent’s Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Lillian Meacham
- Children’s Healthcare of Atlanta Aflac Cancer and Blood Disorders Service, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Shlomo Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sogol Mostoufi Moab
- Divisions of Oncology and Endocrinology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Klinikum Oldenburg AöR, Carl von Ossietzki University Oldenburg, Oldenburg, Germany
| | | | - Manoel H Aguiar Oliveira
- Division of Endocrinology, Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Children, Osaka, Japan
| | - Patricia A Pennisi
- Centro de Investigaciones Endocrinológicas ‘Dr. César Bergadá’, CEDIE-CONICET-FEI, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Vera Popovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sally Radovick
- Department of Pediatrics, Rutgers Robert Wood, Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lars Savendahl
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Division of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine and Gynecological Disorders, Pitie Salpetriere Hospital, Sorbonne Université Medecine, Paris, France
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Chilrdren’s Hospital, University Medical Center and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gudmundur Johannsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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4
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Boguszewski MCS, Cardoso-Demartini AA, Boguszewski CL, Chemaitilly W, Higham CE, Johannsson G, Yuen KCJ. Safety of growth hormone (GH) treatment in GH deficient children and adults treated for cancer and non-malignant intracranial tumors-a review of research and clinical practice. Pituitary 2021; 24:810-827. [PMID: 34304361 PMCID: PMC8416866 DOI: 10.1007/s11102-021-01173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Individuals surviving cancer and brain tumors may experience growth hormone (GH) deficiency as a result of tumor growth, surgical resection and/or radiotherapy involving the hypothalamic-pituitary region. Given the pro-mitogenic and anti-apoptotic properties of GH and insulin-like growth factor-I, the safety of GH replacement in this population has raised hypothetical safety concerns that have been debated for decades. Data from multicenter studies with extended follow-up have generally not found significant associations between GH replacement and cancer recurrence or mortality from cancer among childhood cancer survivors. Potential associations with secondary neoplasms, especially solid tumors, have been reported, although this risk appears to decline with longer follow-up. Data from survivors of pediatric or adult cancers who are treated with GH during adulthood are scarce, and the risk versus benefit profile of GH replacement of this population remains unclear. Studies pertaining to the safety of GH replacement in individuals treated for nonmalignant brain tumors, including craniopharyngioma and non-functioning pituitary adenoma, have generally been reassuring with regards to the risk of tumor recurrence. The present review offers a summary of the most current medical literature regarding GH treatment of patients who have survived cancer and brain tumors, with the emphasis on areas where active research is required and where consensus on clinical practice is lacking.
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Affiliation(s)
- Margaret C S Boguszewski
- Departamento de Pediatria, Universidade Federal do Paraná, Avenida Agostinho Leão Junior, 285 - Alto da Glória, Curitiba, PR, 80030-110, Brazil.
| | | | - Cesar Luiz Boguszewski
- SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Wassim Chemaitilly
- Departments of Pediatric Medicine-Endocrinology and Epidemiology-Cancer Control, St. Jude Children's Research Hospital, Memphis, USA
| | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gudmundur Johannsson
- Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, Departments of Neuroendocrinology and Neurosurgery, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
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5
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Helligsoe ASL, Henriksen LT, Kenborg L, Dehlendorff C, Winther JF, Hasle H. Factors influencing participation rates in clinical late-effect studies of childhood cancer survivors. Pediatr Blood Cancer 2021; 68:e29098. [PMID: 34022113 DOI: 10.1002/pbc.29098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/17/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022]
Abstract
To ensure external validation of a study population in clinical late-effect studies of childhood cancer, the participation rate must be high. This study investigated demographic data in Nordic late-effect studies and potential factors impacting participation rates such as cancer type, time since diagnosis, and duration of clinical examinations. We found 80 published studies originating from 16 cohorts, with median follow-up of 6.0 years (range 3-14). The overall participation rates ranged from 27% to 100%. The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in hematologic malignancies (67%) and central nervous system tumors (73%). The clinical examination in 10 studies (62.5%) lasted for more than 3 hours. Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. We encourage future studies to describe the recruitment process more thoroughly to improve understanding of the factors influencing participation rates.
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Affiliation(s)
- Anne Sophie Lind Helligsoe
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Louise Tram Henriksen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Kenborg
- Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Childhood Cancer Survivorship Research Group, Danish Cancer Society Research Center, Aarhus, Denmark
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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6
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van Iersel L, van Santen HM, Potter B, Li Z, Conklin HM, Zhang H, Chemaitilly W, Merchant TE. Clinical impact of hypothalamic-pituitary disorders after conformal radiation therapy for pediatric low-grade glioma or ependymoma. Pediatr Blood Cancer 2020; 67:e28723. [PMID: 33037871 DOI: 10.1002/pbc.28723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND To determine the impact of hypothalamic-pituitary (HP) disorders on health outcomes in children and adolescents who received conformal radiation therapy (RT) for central nervous system tumors. PROCEDURE Cohort study including 355 patients (age ≤25 years at diagnosis) treated with high-dose (50.4-59.4 Gy) RT using photons for low-grade glioma or ependymoma. Patients (median age, 6.4 years at RT) received systematic endocrine follow-up (median duration, 10.1 years; range, 0.1-19.6). Associations between HP disorders and adverse health outcomes were determined by multivariable analysis. RESULTS Prevalence was 37.2% for growth hormone deficiency (GHD), 17.7% for gonadotropin deficiency (LH/FSHD), 14.9% for thyroid-stimulating hormone deficiency (TSHD), 10.3% for adrenocorticotropic hormone deficiency (ACTHD), and 12.6% for central precocious puberty (CPP). Hypothalamus mean dose ≥ 36 Gy was associated with higher odds of any deficiency. GHD was associated with short stature (OR 2.77; 95% CI 1.34-5.70), low bone mineral density (OR 3.47; 95% CI 1.16-10.40), and TSHD with dyslipidemia (OR 5.54; 95% CI 1.66-18.52). Patients with ACTHD and CPP had lower intelligence quotient scores, and memory scores were impaired in patients with GHD (P = 0.02). Treatment of GHD was not associated with increased risk for tumor recurrence, secondary tumors, or mortality. CONCLUSIONS HP disorders occur frequently in patients receiving high-dose RT and are related to physical and neurocognitive well-being. Future studies are needed to assess whether further optimization of endocrine management yields better health outcomes.
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Affiliation(s)
- Laura van Iersel
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Brian Potter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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7
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Sbardella E, Crocco M, Feola T, Papa F, Puliani G, Gianfrilli D, Isidori AM, Grossman AB. GH deficiency in cancer survivors in the transition age: diagnosis and therapy. Pituitary 2020; 23:432-456. [PMID: 32488760 DOI: 10.1007/s11102-020-01052-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Survival rates among childhood cancer survivors (CCSs) have significantly risen in the last 40 years due to substantial improvements in treatment protocols. However, this improvement has brought with it serious late effects that frequently involve the endocrine system. Of the endocrine disorders, GH deficiency (GHD) is the most common among CCSs as a consequence of a history of cancers, surgery, and/or radiotherapy involving the hypothalamo-pituitary region. METHODS A comprehensive search of English language articles regardless of age was conducted in the MEDLINE database between December 2018 and October 2019. We selected all studies on GH therapy in CCSs during the transition age regarding the most challenging topics: when to retest; which diagnostic tests and cut-offs to use; when to start GH replacement therapy (GHRT); what GH dose to use; safety; quality of life, compliance and adherence to GHRT; interactions between GH and other hormonal replacement treatments. RESULTS In the present review, we provide an overview of the current clinical management of challenges in GHD in cancer survivors in the transition age. CONCLUSIONS Endocrine dysfunction among CCSs has a high prevalence in the transition age and increase with time. Many endocrine disorders, including GHD, are often not diagnosed or under-diagnosed, probably due to the lack of specialized centers for the long-term follow-up. Therefore, it is crucial that transition specialized clinics should be increased in terms of number and specific skills in order to manage endocrine disorders in adolescence, a delicate and complex period of life. A multidisciplinary approach, also including psychological counseling, is essential in the follow-up and management of these patients in order to minimize their disabilities and maximize their quality of life.
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Affiliation(s)
- Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Marco Crocco
- Department of Pediatrics, IRCCS Giannina Gaslini Institute, University of Genoa, Genoa, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Fortuna Papa
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Giulia Puliani
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, OX3 7LE, UK
- Centre for Endocrinology, Barts and the London School of Medicine, London, EC1M 6BQ, UK
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8
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9
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van Iersel L, Li Z, Srivastava DK, Brinkman TM, Bjornard KL, Wilson CL, Green DM, Merchant TE, Pui CH, Howell RM, Smith SA, Armstrong GT, Hudson MM, Robison LL, Ness KK, Gajjar A, Krull KR, Sklar CA, van Santen HM, Chemaitilly W. Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors: Prevalence, Risk Factors and Long-Term Health Outcomes. J Clin Endocrinol Metab 2019; 104:6101-6115. [PMID: 31373627 PMCID: PMC7296130 DOI: 10.1210/jc.2019-00834] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Data on hypothalamic-pituitary (HP) disorders in systematically evaluated childhood cancer survivors are limited. OBJECTIVE To describe prevalence, risk factors, and associated adverse health outcomes of deficiencies in GH deficiency (GHD), TSH deficiency (TSHD), LH/FSH deficiency (LH/FSHD), and ACTH deficiency (ACTHD), and central precocious puberty (CPP). DESIGN Retrospective with cross-sectional health outcomes analysis. SETTING Established cohort; tertiary care center. PATIENTS Participants (N = 3141; median age, 31.7 years) were followed for a median 24.1 years. MAIN OUTCOME MEASURE Multivariable logistic regression was used to calculate ORs and 95% CIs for associations among HP disorders, tumor- and treatment-related risk factors, and health outcomes. RESULTS The estimated prevalence was 40.2% for GHD, 11.1% for TSHD, 10.6% for LH/FSHD, 3.2% for ACTHD, and 0.9% for CPP among participants treated with HP radiotherapy (n = 1089), and 6.2% for GHD, and <1% for other HP disorders without HP radiotherapy. Clinical factors independently associated with HP disorders included HP radiotherapy (at any dose for GHD, TSHD, LH/FSHD, >30 Gy for ACTHD), alkylating agents (GHD, LH/FSHD), intrathecal chemotherapy (GHD), hydrocephalus with shunt placement (GHD, LH/FSHD), seizures (TSHD, ACTHD), and stroke (GHD, TSHD, LH/FSHD, ACTHD). Adverse health outcomes independently associated with HP disorders included short stature (GHD, TSHD), severe bone mineral density deficit (GHD, LH/FSHD), obesity (LH/FSHD), frailty (GHD), impaired physical health-related quality of life (TSHD), sexual dysfunction (LH/FSHD), impaired memory, and processing speed (GHD, TSHD). CONCLUSION HP radiotherapy, central nervous system injury, and, to a lesser extent, chemotherapy are associated with HP disorders, which are associated with adverse health outcomes.
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Affiliation(s)
- Laura van Iersel
- Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Susan A Smith
- Department of Radiation Physics, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Wassim Chemaitilly
- Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Correspondence and Reprint Requests: Wassim Chemaitilly, MD, Department of Pediatric Medicine – Division of Endocrinology, St. Jude Children’s Research Hospital, MS 737, 262 Danny Thomas Place, Memphis, Tennessee 38105. E-mail:
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Tamhane S, Sfeir JG, Kittah NEN, Jasim S, Chemaitilly W, Cohen LE, Murad MH. GH Therapy in Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2018; 103:2794-2801. [PMID: 29982555 DOI: 10.1210/jc.2018-01205] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 02/10/2023]
Abstract
BACKGROUND GH deficiency (GHD) is common among childhood cancer survivors (CCSs) with history of tumors, surgery, and/or radiotherapy involving the hypothalamus-pituitary region. We aimed to evaluate the effects of GH therapy (GHT) in CCSs on adult height, risk of diabetes mellitus, abnormal lipids, metabolic syndrome, quality of life, secondary tumors, and disease recurrence. METHODS We searched multiple databases for randomized and observational studies. Pairs of reviewers independently selected studies and collected data. Random effects meta-analysis was used to pool outcomes across the studies. RESULTS We included 29 observational studies at moderate to high risk of bias. Sixteen studies compared CCSs on GHT with those not on GHT (512 patients, GH dose: 0.3 to 0.9 IU/kg/week). GHT was significantly associated with height gain [standard deviation score, 0.61; 95% CI, 0.08 to 1.13] and was not significantly associated with the occurrence of secondary tumors [odds ratio (OR), 1.10; 95% CI, 0.72 to 1.67] or tumor recurrence (OR, 0.57; 95% CI, 0.31 to 1.02). Thirteen studies compared CCSs on GHT with normal age- or sex-matched controls or controls with idiopathic GHD or short stature. GHT was associated with either improved or unchanged risk of diabetes, lipid profiles, and metabolic syndrome. GHT was associated with improvements in quality of life. CONCLUSION CCSs treated with GHT gain height compared with the untreated controls. GHT may improve lipid profiles and quality of life and does not appear to increase the risk of diabetes or the development of secondary tumors, although close monitoring for such complications remains warranted due to uncertainty in the current evidence.
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Affiliation(s)
- Shrikant Tamhane
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Jad G Sfeir
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | | | - Sina Jasim
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
| | - Wassim Chemaitilly
- Department of Pediatric Medicine, Division of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Laurie E Cohen
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
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11
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Sklar CA, Antal Z, Chemaitilly W, Cohen LE, Follin C, Meacham LR, Murad MH. Hypothalamic-Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018; 103:2761-2784. [PMID: 29982476 DOI: 10.1210/jc.2018-01175] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To formulate clinical practice guidelines for the endocrine treatment of hypothalamic-pituitary and growth disorders in survivors of childhood cancer. PARTICIPANTS An Endocrine Society-appointed guideline writing committee of six medical experts and a methodologist. CONCLUSIONS Due to remarkable improvements in childhood cancer treatment and supportive care during the past several decades, 5-year survival rates for childhood cancer currently are >80%. However, by virtue of their disease and its treatments, childhood cancer survivors are at increased risk for a wide range of serious health conditions, including disorders of the endocrine system. Recent data indicate that 40% to 50% of survivors will develop an endocrine disorder during their lifetime. Risk factors for endocrine complications include both host (e.g., age, sex) and treatment factors (e.g., radiation). Radiation exposure to key endocrine organs (e.g., hypothalamus, pituitary, thyroid, and gonads) places cancer survivors at the highest risk of developing an endocrine abnormality over time; these endocrinopathies can develop decades following cancer treatment, underscoring the importance of lifelong surveillance. The following guideline addresses the diagnosis and treatment of hypothalamic-pituitary and growth disorders commonly encountered in childhood cancer survivors.
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Affiliation(s)
| | - Zoltan Antal
- Memorial Sloan-Kettering Cancer Center, New York, New York
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York
| | | | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
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12
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Prospective evaluation of metabolic syndrome and its features in a single-center series of hematopoietic stem cell transplantation recipients. Ann Hematol 2018; 97:2471-2478. [PMID: 30054704 DOI: 10.1007/s00277-018-3452-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 07/19/2018] [Indexed: 02/01/2023]
Abstract
Available studies on metabolic syndrome (MS) after hematopoietic stem cell transplantation (HSCT) are retrospective with heterogeneous inclusion criteria, and little is known about the early post-transplant phase. In our prospective study, clinical and laboratory data were collected in 100 HSCT recipients, 48 allogeneic and 52 autologous, at baseline, at + 30, + 100 and + 360 days. At baseline, MS was observed in 24 patients, significantly associated with insulin resistance and leptin on multivariate analysis. At + 30, the diagnosis of MS was confirmed in 43 patients, significantly related to insulin resistance and allogeneic transplants. If the whole series was considered, patients with MS had significantly higher mortality from any cause. The baseline presence of any MS feature was a predictor of + 30 MS. Isolated occurrences of MS features were related to hyperleptinemia and hyperinsulinemia, except in the case of low HDL cholesterol, linked to adiponectin and resistin. Our data confirm that patients undergoing HSCT have a high prevalence of MS, with hyperleptinemia playing a major role. The early peak of new MS cases is primarily attributable to insulin resistance, notably but not exclusively immunosuppression-induced; the subsequent long-term increase in MS cases may be an effect of persistent adipokine imbalance.
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13
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Chemaitilly W, Cohen LE, Mostoufi-Moab S, Patterson BC, Simmons JH, Meacham LR, van Santen HM, Sklar CA. Endocrine Late Effects in Childhood Cancer Survivors. J Clin Oncol 2018; 36:2153-2159. [PMID: 29874130 DOI: 10.1200/jco.2017.76.3268] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Endocrine complications are highly prevalent in childhood cancer survivors. Approximately 50% of survivors will experience at least one hormonal disorder over the course of their lives. Endocrine complications often are observed in survivors previously treated with radiation to the head, neck, or pelvis. We provide an overview the most common endocrine late effects seen in survivors, including hypothalamic-pituitary dysfunction, primary thyroid dysfunction, obesity, diabetes mellitus, metabolic syndrome, and decreased bone mineral density. Primary gonadal injury is discussed elsewhere in this series. Given a variable latency interval, a systematic approach where individuals are periodically screened on the basis of their risk factors can help to improve health outcomes by prompt diagnosis and treatment of evolving endocrinopathies. These recommendations must be revised in the future given changes and improvements in cancer treatment over time.
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Affiliation(s)
- Wassim Chemaitilly
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laurie E Cohen
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sogol Mostoufi-Moab
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Briana C Patterson
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jill H Simmons
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lillian R Meacham
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hanneke M van Santen
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles A Sklar
- Wassim Chemaitilly, St Jude Children's Research Hospital, Memphis; Jill H. Simmons, Vanderbilt University Medical Center, Nashville, TN; Laurie E. Cohen, Boston Children's Hospital, Boston, MA; Sogol Mostoufi-Moab, University of Pennsylvania, Philadelphia, PA; Briana C. Patterson and Lillian R. Meacham, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; and Charles A. Sklar, Memorial Sloan Kettering Cancer Center, New York, NY
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Health-related quality of life of survivors of childhood acute lymphoblastic leukemia: a systematic review. Qual Life Res 2018; 27:1431-1443. [DOI: 10.1007/s11136-018-1788-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/09/2023]
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15
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Follin C, Fjalldal S, Svärd D, van Westen D, Gabery S, Petersén Å, Lätt J, Rylander L, Erfurth EM. Microstructure alterations in the hypothalamus in cranially radiated childhood leukaemia survivors but not in craniopharyngioma patients unaffected by hypothalamic damage. Clin Endocrinol (Oxf) 2017; 87:359-366. [PMID: 28502079 DOI: 10.1111/cen.13373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/25/2017] [Accepted: 05/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Metabolic complications are frequent in childhood leukaemia (ALL) survivors treated with cranial radiotherapy (CRT). These complications are potentially mediated by damage to the hypothalamus (HT), as childhood onset (CO) craniopharyngioma (CP) survivors without HT involvement are spared overt obesity. Diffusion tensor imaging (DTI) shows brain tissue microstructure alterations, by fractional anisotrophy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). We used DTI to determine the integrity of the microstructure of the HT in ALL survivors. DESIGN Case-control study. PATIENTS Three groups were included: (i) 27 CRT treated ALL survivors on hormone supplementation, (ii) 17 CO-CP survivors on hormone supplementation but without HT involvement and (iii) 27 matched controls. MEASUREMENTS DTI parameters of the HT were measured and body composition. RESULTS Microstructural alterations in the HT were more severe in ALL survivors with a BMI ≥25 than with BMI <25. Compared to controls, ALL survivors had reduced FA (P=.04), increased MD (P<.001), AD (P<.001) and RD (P<.001) in the right and left HT. In the right HT, ALL survivors with a BMI ≥25 showed elevated MD (P=.03) and AD (P=.02) compared to ALL survivors with BMI <25. In contrast, DTI parameters did not differ between CP survivors and controls. CONCLUSIONS Long-term follow-up after CRT for ALL DTI measures were affected in the HT despite complete hormone replacement. The present data suggest that ALL survivors have demyelination and axonal loss in the HT.
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Affiliation(s)
- Cecilia Follin
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | - Sigridur Fjalldal
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | - Daniel Svärd
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Danielle van Westen
- Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Sanaz Gabery
- Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Åsa Petersén
- Translational Neuroendocrine Research Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Eva Marie Erfurth
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
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Pålsson A, Malmström M, Follin C. Childhood leukaemia survivors' experiences of long-term follow-ups in an endocrine clinic - A focus-group study. Eur J Oncol Nurs 2016; 26:19-26. [PMID: 28069148 DOI: 10.1016/j.ejon.2016.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/30/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
The survival rate after childhood cancer has improved markedly and today more than 80% of patients will survive. Many childhood cancer survivors suffer from late complications due to radiotherapy and chemotherapy. Survivors of Acute Lymphoblastic Leukaemia (ALL), treated with cranial radiotherapy, are at a particularly high risk of having endocrine complications. PURPOSE To illuminate childhood ALL survivors' experiences of a long-term follow-up in an endocrine clinic. METHOD Data collection carried out using semi-structured focus-group interviews. Fifteen ALL survivors were included in the study, divided into 4 groups. Data was analysed with conventional qualitative content analysis. RESULTS The survivors' experiences were captured in the theme: "The need for understanding and support in order to manage daily life". An understanding of their situation, as well as support for managing daily life was fundamental. Lack of understanding and support from the community was connected with a fear for the future. The follow-up at the endocrine clinic was shown to be crucial for increasing the survivors' understanding of late complications. The past feeling of being out of control was replaced with an increased self-confidence. CONCLUSION Many leukaemia survivors experienced their daily lives as a struggle and as a complicated issue to cope with. The theme "understanding and support to manage daily life" mirrors how the survivors are in need of knowledge and support in order to handle and understand their complex situation after surviving leukaemia. Offering understanding and support with a holistic approach, may be a way in which to strengthen the survivors' health.
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Affiliation(s)
- Anna Pålsson
- Department of Endocrinology, Skåne University Hospital, Institution of Clinical Sciences, Lund, Sweden
| | - Marlene Malmström
- Department of Surgery, Skåne University Hospital, Institution of Clinical Sciences, Lund, Sweden
| | - Cecilia Follin
- Department of Endocrinology, Skåne University Hospital, Institution of Clinical Sciences, Lund, Sweden.
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Leroy C, Cortet-Rudelli C, Desailloud R. [Endocrine consequences in young adult survivors of childhood cancer treatment]. ANNALES D'ENDOCRINOLOGIE 2016; 76:S29-38. [PMID: 26776287 DOI: 10.1016/s0003-4266(16)30005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Endocrine complications (particularly gonadal, hypothalamic-pituitary and metabolic) of childhood cancer treatments are common in young adults. Gonadal damage may be the result of chemotherapy or radiotherapy. Fertility preservation must be systematically proposed before initiation of gonadotoxic treatment if only the child is eligible. Hypothalamic-pituitary deficiency is common after brain or total-body irradiation, the somatotropic axis is the most sensitive to irradiation. Pituitary deficiency screening must be repeated since this endocrine consequence can occur many years after treatment. Hormone replacement must be prudent particularly in case of treatment with growth hormone or steroids. Metabolic syndrome, diabetes and cardiovascular damage resulting from cancer treatments contribute to the increase of morbidity and mortality in this population and should be screened routinely even if the patient is asymptomatic. The multidisciplinary management of these adults must be organized and the role of the endocrinologist is now well established.
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Affiliation(s)
- C Leroy
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Claude Huriez, CHRU de Lille, Rue Michel Polonovski, 59037 Lille cedex, France; Service d'Andrologie, Hôpital Calmette, CHRU de Lille, Boulevard du Professeur Jules Leclercq, 59037 Lille cedex, France; Service d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, avenue Eugène Avinée, 59037 Lille cedex, France; Université Lille 2, Faculté de Médecine, Lille, France.
| | - C Cortet-Rudelli
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Claude Huriez, CHRU de Lille, Rue Michel Polonovski, 59037 Lille cedex, France; Université Lille 2, Faculté de Médecine, Lille, France
| | - R Desailloud
- Service d'Endocrinologie, Diabétologie et Nutrition, CHRU d'Amiens, UPJV, Hôpital Sud, Avenue René Laennec 80054 Amiens cedex 1, France; Université de Picardie Jules Verne, Faculté de Médecine, Amiens, France
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Shepard CW, Steinberger J. Premature Atherosclerotic Cardiovascular Disease in Childhood Cancer Survivors. PROGRESS IN PEDIATRIC CARDIOLOGY 2016; 39:59-66. [PMID: 26823646 DOI: 10.1016/j.ppedcard.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Survival rates of childhood cancer have increased over the last 30 years, revealing a population with unique characteristics and risks. The effects of radiation and cardiotoxic chemotherapy predispose these children to both early and late cardiovascular disease. Cranial radiation also increases the likelihood of growth hormone deficiency, which leads to metabolic disturbances. Childhood cancer survivors are less likely to be active than their healthy siblings, and have a lower aptitude for physical activity. These issues are additive to the usual risks experienced by the general population, thereby significantly increasing the likelihood of premature cardiovascular disease. Early and regular screening and risk factor management in this population is recommended.
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Affiliation(s)
- Charles W Shepard
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
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Associations between Metabolic Risk Factors and the Hypothalamic Volume in Childhood Leukemia Survivors Treated with Cranial Radiotherapy. PLoS One 2016; 11:e0147575. [PMID: 26824435 PMCID: PMC4732818 DOI: 10.1371/journal.pone.0147575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022] Open
Abstract
Metabolic complications are prevalent in individuals treated with cranial radiotherapy (CRT) for childhood acute lymphoblastic leukemia (ALL). The hypothalamus is a master regulator of endocrine and metabolic control. The aim of this study was to investigate whether the hypothalamic volume would be associated to metabolic parameters in ALL survivors. Thirty-eight (21 women) survivors participated in this study 34 years after diagnosis and with a median age of 38 (27–46) years. All were treated with a median CRT dose of 24 Gy and 11 years (3–13) of complete hormone supplementation. Comparisons were made to 31 matched controls. We performed analyses of fat mass, fat free mass, plasma (p)-glucose, p-insulin, Homa-Index (a measure of insulin resistance), serum (s)-leptin, s-ghrelin and of the hypothalamic volume in scans obtained by magnetic resonance imaging (MRI) at 3 Tesla. Serum leptin/kg fat mass (r = -0.4, P = 0.04) and fat mass (r = -0.4, P = 0.01) were negatively correlated with the HT volume among ALL survivors, but not among controls. We also detected significantly higher BMI, waist, fat mass, p-insulin, Homa-Index, leptin/kg fat mass and s-ghrelin and significantly lower fat free mass specifically among female ALL survivors (all P<0.01). Interestingly, s-ghrelin levels increased with time since diagnosis and with low age at diagnosis for childhood ALL. Our results showed that leptin/kg fat mass and fat mass were associated with a reduced HT volume 34 years after ALL diagnosis and that women treated with CRT after ALL are at high risk of metabolic abnormalities. Taken together our data suggest that the hypothalamus is involved in the metabolic consequences after CRT in ALL survivors.
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Tonorezos ES, Hudson MM, Edgar AB, Kremer LC, Sklar CA, Wallace WHB, Oeffinger KC. Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer. Lancet Diabetes Endocrinol 2015; 3:545-55. [PMID: 25873569 PMCID: PMC4490990 DOI: 10.1016/s2213-8587(15)00038-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
5 year survival for childhood and adolescent cancer in developed countries is now in excess of 80% and the number of survivors of cancer continues to increase worldwide. After completion of therapy, many of these survivors will face a lifelong risk of endocrine late effects. We summarise the available evidence related to the prevalence and risk factors for endocrine late effects among adult survivors of childhood and adolescent cancer. Present screening, surveillance, and treatment recommendations differ by country and region, so we also highlight the continued effort to harmonise the international guidelines for this population.
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Affiliation(s)
- Emily S Tonorezos
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa M Hudson
- Departments of Oncology, Epidemiology and Cancer Control, and Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Angela B Edgar
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Leontien C Kremer
- Department of Paediatric Oncology, Emma Children's Hospital and Academic Medical Centre, Amsterdam, Netherlands
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - W Hamish B Wallace
- Department of hematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Li C, Liu P, Liu L, Zhang X, Yang P, Sheng H, Bu L, Li H, Qu S. Metabolic syndrome in hematologic malignancies survivors: a meta-analysis. Med Oncol 2014; 32:422. [DOI: 10.1007/s12032-014-0422-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 12/26/2022]
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Annaloro C, Airaghi L, Saporiti G, Onida F, Cortelezzi A, Deliliers GL. Metabolic syndrome in patients with hematological diseases. Expert Rev Hematol 2014; 5:439-58. [DOI: 10.1586/ehm.12.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Erfurth EM. Uncertainties in endocrine substitution therapy for central endocrine insufficiencies: growth hormone deficiency. HANDBOOK OF CLINICAL NEUROLOGY 2014; 124:407-416. [PMID: 25248603 DOI: 10.1016/b978-0-444-59602-4.00028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The growth hormone deficiency (GHD) syndrome is associated with several metabolic abnormalities and it has been postulated that the increased cardiovascular disease (CVD) morbidity and mortality in GHD patients may be related to the missing metabolic effects of GH. Many CVD risk factors show improvements after GH therapy. Reduced bone mineral density (BMD) has been recorded both in patients with isolated GHD and in those with multiple pituitary deficiencies, indicating that GHD per se is responsible for the low BMD in both types of patients. These matters are, however, more complicated, as hypopituitary patients with GHD may have different phenotypes due to differences in underlying diagnoses. These phenotypes may not be clear-cut in individual patients. Moreover, patients may transit between different phenotypes over time due to extension of the pathology in the pituitary and/or the consequences of the treatment (surgery and/or radiotherapy). Three different phenotypes of hypopituitary patients will be discussed, with a focus on CVD risk and bone health: (1) patients with isolated GHD, e.g. due to prophylactic cranial radiotherapy for lymphoblastic leukaemia in childhood; (2) patients with GHD and multiple hormone deficiencies due to pituitary macroadenomas treated by surgery; (3) patients with GHD caused by craniopharyngiomas with multiple hormone deficiencies and hypothalamic involvement, where hypothalamic damage frequently dominates the positive metabolic effects of GH therapy. These phenotypes illustrate the differential impact of various pituitary pathologies on the phenotype of patients with GHD.
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Lipshultz SE, Adams MJ, Colan SD, Constine LS, Herman EH, Hsu DT, Hudson MM, Kremer LC, Landy DC, Miller TL, Oeffinger KC, Rosenthal DN, Sable CA, Sallan SE, Singh GK, Steinberger J, Cochran TR, Wilkinson JD. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation 2013; 128:1927-95. [PMID: 24081971 DOI: 10.1161/cir.0b013e3182a88099] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
During the last 20 years a tremendous improvement in the care of patients with pituitary tumors and of hypopituitarism has been achieved. If we resolve most of the possible causes of the increased cardiovascular disease and stroke mortality a normal survival is expected in these patients. Recently, a large population based study showed a decline in the risk of non-fatal stroke and of non-fatal cardiac events in GH deficient patients. This improvement was achieved by complete hormone replacement, including long term GH replacement, together with prescription of cardio protective drugs. If we follow the latest achievements in pituitary imaging, surgery techniques, hormone substitutions, cardio protective medications, we would expect a normal longevity in these patients. This review will focus on; (1) pituitary insufficiencies and hormone substitutions, (2) modes of cranial radiotherapy, and (3) new techniques in the surgery of a pituitary adenoma.
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Affiliation(s)
- Eva Marie Erfurth
- Department of Endocrinology, Skånes University Hospital, 221 85, Lund, Sweden.
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Landy DC, Miller TL, Lipsitz SR, Lopez-Mitnik G, Hinkle AS, Constine LS, Adams MJ, Lipshultz SE. Cranial irradiation as an additional risk factor for anthracycline cardiotoxicity in childhood cancer survivors: an analysis from the cardiac risk factors in childhood cancer survivors study. Pediatr Cardiol 2013; 34:826-34. [PMID: 23080542 PMCID: PMC3594453 DOI: 10.1007/s00246-012-0539-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
Abstract
Anthracycline-treated childhood cancer survivors experience cardiac damage that results in decreased left ventricular (LV) mass, leading to increased LV wall stress, which underlies their greater risk of cardiomyopathy. Many of these survivors also are at risk of growth hormone (GH) abnormalities from cranial irradiation exposure, although it is unknown whether such exposure is associated with cardiotoxicity. Echocardiograms and insulin-like growth factor-1 (IGF-1), a marker of GH, were measured in 130 anthracycline-treated childhood cancer survivors, 59 of whom had been exposed to cranial irradiation, a mean 10 years after their cancer diagnosis. Echocardiographic parameters and IGF-1 were standardized relative to age or body surface area using data from sibling control subjects and expressed as the percentage difference from normal values. The results showed that after adjustment for other risk factors, survivors exposed to cranial irradiation had an additional 12 % decrease in LV mass compared with unexposed survivors (P < 0.01) and an additional 3.6 % decrease in LV dimension (P = 0.03). Survivors exposed to cranial irradiation also had a 30.8 % decrease in IGF-1 relative to normal values, which was greater than the 10.5 % decrease in unexposed survivors (P < 0.01). The above findings led us to conclude that in anthracycline-treated childhood cancer survivors a mean 10 years after their diagnosis, those with cranial irradiation exposure had significantly greater decreases in LV mass and dimension. Because cranial irradiation also was associated with decreased IGF-1, it is possible that GH deficiencies mediated this effect, suggesting that GH replacement therapy may help to prevent the development of cardiotoxicity.
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Affiliation(s)
- David C. Landy
- Division of Pediatric Clinical Research, Department of Pediatrics and Bachelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Tracie L. Miller
- Division of Pediatric Clinical Research, Department of Pediatrics and Bachelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | | | - Gabriela Lopez-Mitnik
- Division of Pediatric Clinical Research, Department of Pediatrics and Bachelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Andrea S. Hinkle
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Louis S. Constine
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - M. Jacob Adams
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Steven E. Lipshultz
- Division of Pediatric Clinical Research, Department of Pediatrics and Bachelor Children’s Research Institute, University of Miami Miller School of Medicine, Miami, FL,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Petryk A, Baker KS, Frohnert B, Moran A, Chow L, Sinaiko AR, Steffen LM, Perkins JL, Zhang L, Hodges JS, Steinberger J. Blunted response to a growth hormone stimulation test is associated with unfavorable cardiovascular risk factor profile in childhood cancer survivors. Pediatr Blood Cancer 2013; 60:467-73. [PMID: 23002034 PMCID: PMC3529966 DOI: 10.1002/pbc.24308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 08/08/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at risk for growth hormone (GH) deficiency. CCS are also at increased risk for early mortality from cardiovascular (CV) disease, but the association between GH levels and CV risk remains poorly understood. The goal of this study was to examine the cross-sectional association between stimulated GH levels and CV risk factors in CCS younger than 18 years. PROCEDURE A total of 276 CCS (147 males, 14.4 ± 2.6 years) ≥5 years after cancer diagnosis, and 208 sibling controls (112 males, 13.6 ± 2.4 years) participated in this cross-sectional study, which included anthropometry, body composition, and metabolic studies. Blunted response (BR) was defined as peak GH level <7 µg/L after clonidine and arginine. Insulin sensitivity (M(lbm) ) was measured by euglycemic hyperinsulinemic clamp. Statistical analyses used linear and logistic regression accounting for sibling clustering, adjusted for age, sex, Tanner stage, and adiposity. RESULTS Thirty-four (12%) CCS showed BR to GH stimulation. BR CCS were shorter and had a lower IGF-1 than controls; only 6 of 34 received cranial radiation therapy. CCS with normal stimulated GH response were similar to controls for CV risk factors. Conversely, BR CCS had greater adiposity, higher lipids, and lower M(lbm) than controls. Differences in lipids and M(lbm) between BR CCS and controls remained significant after adjustment for BMI or visceral fat. CONCLUSIONS BR to GH stimulation is prevalent in CCS youth and is associated with an unfavorable CV risk factor profile. Further studies are needed to establish the mechanisms of these associations.
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Affiliation(s)
- Anna Petryk
- Pediatric Endocrinology, University of Minnesota Amplatz Children's Hospital, Minneapolis, Minnesota 55454, USA.
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Bang KW, Seo SY, Lee JW, Jang PS, Jung MH, Chung NG, Cho B, Jeong DC, Suh BK, Kim HK. Evaluation of changes in random blood glucose and body mass index during and after completion of chemotherapy in children with acute lymphoblastic leukemia. KOREAN JOURNAL OF PEDIATRICS 2012; 55:121-7. [PMID: 22574072 PMCID: PMC3346834 DOI: 10.3345/kjp.2012.55.4.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/28/2011] [Accepted: 11/22/2011] [Indexed: 11/29/2022]
Abstract
Purpose Improved survival of patients with childhood acute lymphoblastic leukemia (ALL) has drawn attention to the potential for late consequences of previous treatments among survivors, including metabolic syndrome. In this study, we evaluated changes in 3 parameters, namely, random blood glucose, body mass index (BMI), and Z score for BMI (Z-BMI), in children with ALL during chemotherapy and after completion of treatment. Methods Patients newly diagnosed with ALL from January, 2005 to December, 2008 at Saint Mary's Hospital, The Catholic University of Korea, who completed treatment with chemotherapy only were included (n=107). Random glucose, BMI, and Z-BMI were recorded at 5 intervals: at diagnosis, before maintenance treatment, at completion of maintenance treatment, and 6 and 12 months after completion of maintenance treatment. Similar analyses were conducted on 2 subcohorts based on ALL risk groups. Results For random glucose, a paired comparison showed significantly lower levels at 12 months post-treatment compared to those at initial diagnosis (P<0.001) and before maintenance (P<0.001). The Z-BMI score was significantly higher before maintenance than at diagnosis (P<0.001), but decreased significantly at the end of treatment (P<0.001) and remained low at 6 months (P<0.001) and 12 months (P<0.001) post-treatment. Similar results were obtained upon analysis of risk group-based subcohorts. Conclusion For a cohort of ALL patients treated without allogeneic transplantation or cranial irradiation, decrease in random glucose and Z-BMI after completion of chemotherapy does not indicate future glucose intolerance or obesity.
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Affiliation(s)
- Kyong-Won Bang
- Department of Pediatrics, The Catholic University of Korea, School of Medicine, Seoul, Korea
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Fulbright JM, Raman S, McClellan WS, August KJ. Late Effects of Childhood Leukemia Therapy. Curr Hematol Malig Rep 2011; 6:195-205. [DOI: 10.1007/s11899-011-0094-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW We review recent developments in the therapy of growth disorders, focusing mainly on recent developments in the field of growth hormone (GH) therapy. RECENT FINDINGS Review of current practice reveals wide variation in the approach to short stature and the institution of GH therapy. No new indications for GH treatment have been approved by the Food and Drug Administration since 2007, but off-label use has been explored in several chronic illnesses. There is also increasing focus on GH effects beyond increase in stature (e.g. effects on body composition and bone density). As the experience with GH increases, the long-term risks and outcomes are better understood and risks appear to be low. Data regarding beneficial effects of GH in Prader-Willi syndrome are accumulating but questions remain about patient selection, start age and safety. Recombinant insulin-like growth factor 1 has become more widely available and has been aggressively promoted for Food and Drug Administration-approved indications as well as off-label uses in the last few years. The use of aromatase inhibitors has been tempered by concern about side-effects and lack of efficacy. SUMMARY Growth hormone remains the mainstay of therapy for growth disorders, though other options, including recombinant insulin-like growth factor 1, are being investigated in various settings.
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Affiliation(s)
- Omar Ali
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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