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van Schaik J, van Roessel IMAA, Bos ID, Claashen-van der Grinten HL, Clement SC, van Iersel L, Bakker B, Meijer L, Kremer L, Schouten-van Meeteren AYN, van Santen HM. Elevated IGF-1 concentrations in children with low grade glioma: A descriptive analysis in a retrospective national cohort. J Neuroendocrinol 2023; 35:e13317. [PMID: 37439273 DOI: 10.1111/jne.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 07/14/2023]
Abstract
Children with low grade glioma (LGG) may present with, or develop, elevated concentrations of insulin-like growth factor 1 (IGF-1). The prevalence, pathophysiology, or its possible clinical effects are poorly understood. Our aim was to evaluate the prevalence of such elevated IGF-1 concentrations and to describe its association with linear growth, body mass index (BMI), pituitary outcome, and tumor behavior in a large retrospective national cohort. From a nationwide retrospective cohort of pediatric brain tumor survivors diagnosed between 2002 and 2012, tumor, treatment, endocrine, and auxological data of children with LGG were collected (n = 358). Prevalence and risk factors for elevated IGF-1 concentrations, as well as the association between having elevated IGF-1 concentrations and receiving tumor treatment, were explored. IGF-1 concentrations had only been measured in 45.5% of cases (n = 163/358). In 18.4% of 163 children with available IGF-1 measurements, IGF-1 concentrations were found elevated. No association was described between having an elevated IGF-1 concentration and tumor behavior or height SDS at last moment of follow-up. Multivariate logistic regression identified posterior pituitary disorder (OR 6.14 95% CI: 2.21-17.09) and BMI SDS at follow-up (OR 1.56 95% CI: 1.09-2.20) to be significantly associated with elevated IGF-1 concentrations. In this retrospective cohort of children with LGG, IGF-1 was found elevated in 18.4% of children with available IGF-1 measurements. Elevated IGF-1 seems to be related to hypothalamic dysfunction worsening over time. Larger prospective cohort studies are needed.
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Affiliation(s)
- Jiska van Schaik
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ichelle M A A van Roessel
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Iris D Bos
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Sarah C Clement
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laura van Iersel
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Boudewijn Bakker
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisethe Meijer
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien Kremer
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Hanneke M van Santen
- Division of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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2
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Clement SC, Visser WE, Lebbink CA, Albano D, Claahsen-van der Grinten HL, Czarniecka A, Dias RP, Dierselhuis MP, Dzivite-Krisane I, Elisei R, Garcia-Burillo A, Izatt L, Kanaka-Gantenbein C, Krude H, Lamartina L, Lorenz K, Luster M, Navardauskaitė R, Negre Busó M, Newbold K, Peeters RP, Pellegriti G, Piccardo A, Priego AL, Redlich A, de Sanctis L, Sobrinho-Simões M, van Trotsenburg ASP, Verburg FA, Vriens M, Links TP, Ahmed SF, van Santen HM. Development of a pediatric differentiated thyroid carcinoma registry within the EuRRECa project: rationale and protocol. Endocr Connect 2023; 12:e220306. [PMID: 37931414 PMCID: PMC9986407 DOI: 10.1530/ec-22-0306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 10/06/2023]
Abstract
Background Although differentiated thyroid carcinoma (DTC) is the most frequent endocrine pediatric cancer, it is rare in childhood and adolescence. While tumor persistence and recurrence are not uncommon, mortality remains extremely low. Complications of treatment are however reported in up to 48% of the survivors. Due to the rarity of the disease, current treatment guidelines are predominantly based on the results of small observational retrospective studies and extrapolations from results in adult patients. In order to develop more personalized treatment and follow-up strategies (aiming to reduce complication rates), there is an unmet need for uniform international prospective data collection and clinical trials. Methods and analysis The European pediatric thyroid carcinoma registry aims to collect clinical data for all patients ≤18 years of age with a confirmed diagnosis of DTC who have been diagnosed, assessed, or treated at a participating site. This registry will be a component of the wider European Registries for Rare Endocrine Conditions project which has close links to Endo-ERN, the European Reference Network for Rare Endocrine Conditions. A multidisciplinary expert working group was formed to develop a minimal dataset comprising information regarding demographic data, diagnosis, treatment, and outcome. We constructed an umbrella-type registry, with a detailed basic dataset. In the future, this may provide the opportunity for research teams to integrate clinical research questions. Ethics and dissemination Written informed consent will be obtained from all participants and/or their parents/guardians. Summaries and descriptive analyses of the registry will be disseminated via conference presentations and peer-reviewed publications.
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Affiliation(s)
- S C Clement
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
| | - W E Visser
- Academic Center For Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - D Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy
| | - H L Claahsen-van der Grinten
- Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - A Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - R P Dias
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham Women’s, and Children’s NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M P Dierselhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - I Dzivite-Krisane
- Department of Pediatric Endocrinology, Children's Clinical University Hospital, Riga, Latvia
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Garcia-Burillo
- Nuclear Medicine Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - C Kanaka-Gantenbein
- Division of Endocrinology, Diabetes, and Metabolism, First Department of Pediatrics National and Kapodistrian University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - H Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - L Lamartina
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - K Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - M Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - R Navardauskaitė
- Department of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - M Negre Busó
- Nuclear Medicine Service - Institut de diagnòstic per la Imatge, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - K Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust Hospital, London, UK
| | - R P Peeters
- Academic Center For Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G Pellegriti
- Endocrinology, Endocrinology Division, Garibaldi-Nesima Medical Center, Catania, Italy
| | - A Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - A L Priego
- Department of Medicine, Division of Endocrinology, Leiden, University medical Center, Leiden, The Netherlands
| | - A Redlich
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - L de Sanctis
- Regina Margherita Children Hospital - Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - M Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - F A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - M Vriens
- Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T P Links
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - S F Ahmed
- Endocrinology, Endocrinology Division, Garibaldi-Nesima Medical Center, Catania, Italy
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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3
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Heinzel A, Müller D, van Santen HM, Clement SC, Schneider AB, Verburg FA. The effect of surveillance for differentiated thyroid carcinoma in childhood cancer survivors on survival rates: a decision-tree-based analysis. Endocr Connect 2022; 11:e220092. [PMID: 36240044 PMCID: PMC9716375 DOI: 10.1530/ec-22-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Abstract
Background Childhood cancer survivors (CCS) who received radiation therapy exposing the thyroid gland are at increased risk of developing differentiated thyroid cancer (DTC). Therefore, the International Guideline Harmonization Group (IGHG) on late effects of childhood cancer therefore recommends surveillance. It is unclear whether surveillance reduces mortality. Aim The aim of this study was to compare four strategies for DTC surveillance in CCS with the aim of reducing mortality: Strategy-1, no surveillance; Strategy-2, ultrasound alone; Strategy-3, ultrasound followed by fine-needle biopsy (FNB); Strategy-4, palpation followed by ultrasound and FNB. Materials and methods A decision tree was formulated with 10-year thyroid cancer-specific survival as the endpoint, based on data extracted from literature. Results It was calculated that 12.6% of CCS will develop DTC. Using Strategy-1, all CCS with DTC would erroneously not be operated upon, but no CCS would have unnecessary surgery. With Strategy-2, all CCS with and 55.6% of CCS without DTC would be operated. Using Strategy-3, 11.1% of CCS with DTC would be correctly operated upon, 11.2% without DTC would be operated upon and 1.5% with DTC would not be operated upon. With Strategy-4, these percentages would be 6.8, 3.9 and 5.8%, respectively. Median 10-year survival rates would be equal across strategies (0.997). Conclusion Different surveillance strategies for DTC in CCS all result in the same high DTC survival. Therefore, the indication for surveillance may lie in a reduction of surgery-related morbidity rather than DTC-related mortality. In accordance with the IGHG guidelines, the precise strategy should be decided upon in a process of shared decision-making.
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Affiliation(s)
- Alexander Heinzel
- RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Hanneke M van Santen
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sarah C Clement
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Department of Pediatrics, Amsterdam, The Netherlands
| | - Arthur B Schneider
- University of Illinois at Chicago, Department of Medicine, Chicago, IL, USA
| | - Frederik A Verburg
- Erasmus MC Rotterdam, Department of Radiology & Nuclear Medicine, Rotterdam, The Netherlands
- University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany
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4
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van Iersel L, Mulder RL, Denzer C, Cohen LE, Spoudeas HA, Meacham LR, Sugden E, Schouten-van Meeteren AYN, Hoving EW, Packer RJ, Armstrong GT, Mostoufi-Moab S, Stades AM, van Vuurden D, Janssens GO, Thomas-Teinturier C, Murray RD, Di Iorgi N, Neggers SJCMM, Thompson J, Toogood AA, Gleeson H, Follin C, Bardi E, Torno L, Patterson B, Morsellino V, Sommer G, Clement SC, Srivastava D, Kiserud CE, Fernandez A, Scheinemann K, Raman S, Yuen KCJ, Wallace WH, Constine LS, Skinner R, Hudson MM, Kremer LCM, Chemaitilly W, van Santen HM. Hypothalamic-Pituitary and Other Endocrine Surveillance Among Childhood Cancer Survivors. Endocr Rev 2022; 43:794-823. [PMID: 34962573 DOI: 10.1210/endrev/bnab040] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 12/12/2022]
Abstract
Endocrine disorders in survivors of childhood, adolescent, and young adult (CAYA) cancers are associated with substantial adverse physical and psychosocial effects. To improve appropriate and timely endocrine screening and referral to a specialist, the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) aims to develop evidence and expert consensus-based guidelines for healthcare providers that harmonize recommendations for surveillance of endocrine disorders in CAYA cancer survivors. Existing IGHG surveillance recommendations for premature ovarian insufficiency, gonadotoxicity in males, fertility preservation, and thyroid cancer are summarized. For hypothalamic-pituitary (HP) dysfunction, new surveillance recommendations were formulated by a guideline panel consisting of 42 interdisciplinary international experts. A systematic literature search was performed in MEDLINE (through PubMed) for clinically relevant questions concerning HP dysfunction. Literature was screened for eligibility. Recommendations were formulated by drawing conclusions from quality assessment of all evidence, considering the potential benefits of early detection and appropriate management. Healthcare providers should be aware that CAYA cancer survivors have an increased risk for endocrine disorders, including HP dysfunction. Regular surveillance with clinical history, anthropomorphic measures, physical examination, and laboratory measurements is recommended in at-risk survivors. When endocrine disorders are suspected, healthcare providers should proceed with timely referrals to specialized services. These international evidence-based recommendations for surveillance of endocrine disorders in CAYA cancer survivors inform healthcare providers and highlight the need for long-term endocrine follow-up care in subgroups of survivors and elucidate opportunities for further research.
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Affiliation(s)
- Laura van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renee L Mulder
- Princess Máxima Center for Pediatric Oncology, Department of Neuro-oncology, Utrecht, The Netherlands
| | - Christian Denzer
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics & Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Laurie E Cohen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Dana Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Helen A Spoudeas
- The London Centre for Pediatric Endocrinology & Diabetes, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,The London Centre for Pediatric Endocrinology and Diabetes, University College London Hospital, London, UK
| | - Lillian R Meacham
- Emory University School of Medicine; Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA,USA
| | | | | | - Eelco W Hoving
- Princess Máxima Center for Pediatric Oncology, Department of Neuro-oncology, Utrecht, The Netherlands
| | - Roger J Packer
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA,USA
| | - Aline M Stades
- Department of Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dannis van Vuurden
- Princess Máxima Center for Pediatric Oncology, Department of Neuro-oncology, Utrecht, The Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Department of Neuro-oncology, Utrecht, The Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cécile Thomas-Teinturier
- Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health (CESP), Université Paris-Sud XI, Villejuif, France.,Department of Pediatric Endocrinology, APHP, Hôpitaux Paris-Sud, Site Bicetre, Le Kremlin-Bicetre, France
| | - Robert D Murray
- Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Sebastian J C M M Neggers
- Department of Internal Medicine, Endocrinology Section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joel Thompson
- Division of Hematology/Oncology/BMT, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Andrew A Toogood
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Helena Gleeson
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Cecilia Follin
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Edit Bardi
- Department of Pediatrics and Adolescent Medicine, Kepler Universitätsklinikum, Linz, Austria.,St Anna Childrens Hospital, Vienna, Austria
| | - Lilibeth Torno
- Division of Pediatric Oncology, CHOC Children's Hospital/University of California, Orange, CA, USA
| | - Briana Patterson
- Emory University School of Medicine; Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA,USA
| | - Vera Morsellino
- DOPO Clinic, Division of Pediatric Hematology/Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Grit Sommer
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital, University of Bern, Switzerland
| | - Sarah C Clement
- Department of Pediatrics, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis TN, USA
| | - Cecilie E Kiserud
- Department of Oncology, National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Alberto Fernandez
- Endocrinology Department, Hospital Universitario de Mostoles, Madrid, Spain
| | - Katrin Scheinemann
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland.,Division of Pediatric Hematology/Oncology, University Children's Hospital Basel and University of Basel, Basel, Switzerland.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital and McMaster University, Hamilton, ON, Canada
| | - Sripriya Raman
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Pittsburgh, Pittsburgh, PA,USA
| | - Kevin C J Yuen
- Department of Neuroendocrinology and Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - W Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, and Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Department of Neuro-oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wassim Chemaitilly
- Division of Endocrinology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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5
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Clement SC, Tytgat GAM, van Trotsenburg ASP, Kremer LCM, van Santen HM. Thyroid function after diagnostic 123I-metaiodobenzylguanidine in children with neuroblastic tumors. Ann Nucl Med 2022; 36:579-585. [PMID: 35499668 PMCID: PMC9132835 DOI: 10.1007/s12149-022-01743-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metaiodobenzylguanidine (MIBG) labeled with radioisotopes can be used for diagnostics 123I-) and treatment (131I-) in patients with neuroblastic tumors. Thyroid dysfunction has been reported in 52% of neuroblastoma (NBL) survivors after 131I-MIBG, despite thyroid protection. Diagnostic 123I-MIBG is not considered to be hazardous for thyroid function; however, this has never been investigated. Therefore, the aim of this study was to evaluate the prevalence of thyroid dysfunction in survivors of a neuroblastic tumor who received diagnostic 123I-MIBG only. METHODS Thyroid function and uptake of 123I- in the thyroid gland after 123I-MIBG administrations were evaluated in 48 neuroblastic tumor survivors who had not been treated with 131I-MIBG. All patients had received thyroid prophylaxis consisting of potassium iodide or a combination of potassium iodide, thiamazole and thyroxine during exposure to 123I-MIBG. RESULTS After a median follow-up of 6.6 years, thyroid function was normal in 46 of 48 survivors (95.8%). Two survivors [prevalence 4.2% (95% CI 1.2-14.0)] had mild thyroid dysfunction. In 29.2% of the patients and 11.1% of images 123I- uptake was visible in the thyroid. In 1 patient with thyroid dysfunction, weak uptake of 123I- was seen on 1 of 10 images. CONCLUSIONS The prevalence of thyroid dysfunction does not seem to be increased in patients with neuroblastic tumors who received 123I-MIBG combined with thyroid protection. Randomized controlled trials are required to investigate whether administration of 123I-MIBG without thyroid protection is harmful to the thyroid gland.
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Affiliation(s)
- Sarah C Clement
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | | | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, The Netherlands. .,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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6
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van Roessel IMAA, van Schaik J, Meeteren AYNSV, Boot AM, der Grinten HLCV, Clement SC, van Iersel L, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Body mass index at diagnosis of a childhood brain tumor; a reflection of hypothalamic-pituitary dysfunction or lifestyle? Support Care Cancer 2022; 30:6093-6102. [PMID: 35416504 PMCID: PMC9135856 DOI: 10.1007/s00520-022-07031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Childhood brain tumor survivors (CBTS) are at risk of becoming overweight, which has been shown to be associated with hypothalamic-pituitary (HP) dysfunction during follow-up. Body mass index (BMI) at diagnosis is related to BMI at follow-up. It is uncertain, however, whether aberrant BMI at brain tumor diagnosis reflects early hypothalamic dysfunction or rather reflects genetic and sociodemographic characteristics. We aimed to examine whether BMI at childhood brain tumor diagnosis is associated with HP dysfunction at diagnosis or its development during follow-up. METHODS The association of BMI at diagnosis of a childhood brain tumor to HP dysfunction at diagnosis or during follow-up was examined in a Dutch cohort of 685 CBTS, excluding children with craniopharyngioma or a pituitary tumor. Individual patient data were retrospectively extracted from patient charts. RESULTS Of 685 CTBS, 4.7% were underweight, 14.2% were overweight, and 3.8% were obese at diagnosis. Being overweight or obese at diagnosis was not associated with anterior pituitary deficiency or diabetes insipidus at diagnosis or during follow-up. In children with suprasellar tumors, being obese at diagnosis was associated with central precocious puberty. CONCLUSION Overweight or obesity at diagnosis of a childhood brain tumor seems not to be associated with pituitary deficiencies. These results suggest that genetics and lifestyle may be more important etiologic factors for higher BMI at diagnosis in these children than hypothalamic dysfunction. To improve the long-term outcome of CBTS with regards to overweight and obesity, more attention should be given to lifestyle already at the time of brain tumor treatment.
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Affiliation(s)
- I M A A van Roessel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - J van Schaik
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - A Y N Schouten-van Meeteren
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S C Clement
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Amsterdam University Medical Centers, University of Amsterdam, and VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. .,Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
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7
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Lebbink CA, Ringers TP, Schouten-van Meeteren AYN, van Iersel L, Clement SC, Boot AM, Claahsen-van der Grinten HL, Janssens GO, van Vuurden DG, Michiels EM, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Prevalence and risk factors of hypothalamic-pituitary dysfunction in infant and toddler childhood brain tumor survivors. Eur J Endocrinol 2021; 185:597-606. [PMID: 34324432 DOI: 10.1530/eje-21-0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022]
Abstract
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 the less frequent use of radiotherapy (RT) in infants, no differences in the prevalence of HPD were found between the three groups. RT (OR: 16.44; 95% CI: 8.93-30.27), suprasellar tumor location (OR: 44.76; 95% CI: 19.00-105.49), and younger age (OR: 1.11; 95% CI: 1.05-1.18) 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 a young age.
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Affiliation(s)
- C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - T P Ringers
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | | | - L van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - S C Clement
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - A M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H L Claahsen-van der Grinten
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - G O Janssens
- Department of Radiation Oncology, Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - D G van Vuurden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - E M Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - K S Han
- Department of Neurosurgery, University Medical Center Utrecht, The Netherlands
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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8
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Lebbink CA, Ringers TP, Schouten-van Meeteren AYN, van Iersel L, Clement SC, Boot AM, Claahsen-van der Grinten HL, Janssens GOR, van Vuurden DG, Michiels EM, Han KS, van Trotsenburg ASP, Vandertop WP, Kremer LCM, van Santen HM. Prevalence and Risk Factors of Hypothalamic-Pituitary Dysfunction in Infant and Toddler Brain Tumor Survivors. J Endocr Soc 2021. [PMCID: PMC8090318 DOI: 10.1210/jendso/bvab048.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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 >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<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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Affiliation(s)
- Chantal A Lebbink
- Wilhelmina Children’s Hospital, University Medical Center Utrecht & Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Tiara P Ringers
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Laura van Iersel
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sarah C Clement
- Emma Children’s Hospital, Academical Medical Center, Amsterdam, Netherlands
| | | | | | | | | | - Erna M Michiels
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - K Sen Han
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Hanneke M van Santen
- Wilhelmina Children’s Hospital, Univerisity Medical Center Utrecht & Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
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9
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van Schaik J, van Roessel IMAA, Schouten-van Meeteren NAYN, van Iersel L, Clement SC, Boot AM, Claahsen-van der Grinten HL, Fiocco M, Janssens GO, van Vuurden DG, Michiels EM, Han SKS, van Trotsenburg PASP, Vandertop PWP, Kremer LCM, van Santen HM. High Prevalence of Weight Gain in Childhood Brain Tumor Survivors and Its Association With Hypothalamic-Pituitary Dysfunction. J Clin Oncol 2021; 39:1264-1273. [PMID: 33621126 DOI: 10.1200/jco.20.01765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Jiska van Schaik
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ichelle M A A van Roessel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Laura van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sarah C Clement
- Department of Pediatrics, VU Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Annemieke M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Marta Fiocco
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Institute of Mathematics, Leiden University, Leiden, the Netherlands
| | - Geert O Janssens
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Radiation Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Erna M Michiels
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Sen K S Han
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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10
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van Santen HM, Alexander EK, Rivkees SA, Frey E, Clement SC, Dierselhuis MP, Lebbink CA, Links TP, Lorenz K, Peeters RP, Reiners C, Vriens MR, Nathan P, Schneider AB, Verburg F. Clinical considerations for the treatment of secondary differentiated thyroid carcinoma in childhood cancer survivors. Eur J Endocrinol 2020; 183:P1-P10. [PMID: 32508309 DOI: 10.1530/eje-20-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/04/2020] [Indexed: 11/08/2022]
Abstract
The incidence of differentiated thyroid carcinoma (DTC) has increased rapidly over the past several years. Thus far, the only conclusively established risk factor for developing DTC is exposure to ionizing radiation, especially when the exposure occurs in childhood. Since the number of childhood cancer survivors (CCS) is increasing due to improvements in treatment and supportive care, the number of patients who will develop DTC after surviving childhood cancer (secondary thyroid cancer) is also expected to rise. Currently, there are no recommendations for management of thyroid cancer specifically for patients who develop DTC as a consequence of cancer therapy during childhood. Since complications or late effects from prior cancer treatment may elevate the risk of toxicity from DTC therapy, the medical history of CCS should be considered carefully in choosing DTC treatment. In this paper, we emphasize how the occurrence and treatment of the initial childhood malignancy affects the medical and psychosocial factors that will play a role in the diagnosis and treatment of a secondary DTC. We present considerations for clinicians to use in the management of patients with secondary DTC, based on the available evidence combined with experience-based opinions of the authors.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Erik K Alexander
- Department of Endocrinology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Scott A Rivkees
- Department of Pediatrics, University of Florida, Florida, USA
| | - Eva Frey
- Department of Pediatric Oncology, Vienna
| | - Sarah C Clement
- Department of Pediatrics, Free University Hospital Amsterdam, Amsterdam, the Netherlands
| | - Miranda P Dierselhuis
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, the Netherlands
| | - Chantal A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, and Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center, Groningen, Netherlands Department of endocrinology, UMCG, Groningen, Netherlands
| | - Kerstin Lorenz
- Department of Visceral-, Vascular-, and Endocrine Surgery, Universityclinic Halle, Germany
| | - Robin P Peeters
- Department of Endocrinology, Erasmus Medical Center, the Netherlands
| | | | - Menno R Vriens
- Department of Endocrine Surgery, UMC Utrecht, Netherlands
| | - Paul Nathan
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Arthur B Schneider
- Department of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frederik Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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11
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Clement SC, Lebbink CA, Klein Hesselink MS, Teepen JC, Links TP, Ronckers CM, van Santen HM. Presentation and outcome of subsequent thyroid cancer among childhood cancer survivors compared to sporadic thyroid cancer: a matched national study. Eur J Endocrinol 2020; 183:169-180. [PMID: 32449692 DOI: 10.1530/eje-20-0153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/20/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Childhood cancer survivors (CCS) are at increased risk to develop differentiated thyroid cancer predominantly after radiotherapy (subsequent DTC). It is insufficiently known whether subsequent DTC in CCS has a different presentation or outcome than sporadic DTC. METHODS Patients with subsequent DTC (n = 31) were matched to patients with sporadic DTC (n = 93) on gender, age and year of diagnosis to compare presentation and DTC outcomes. Clinical data were collected retrospectively. RESULTS Among the CCS with subsequent DTC, all but one had received chemotherapy for their childhood cancer, 19 (61.3%) had received radiotherapy including the thyroid region, 3 (9.7%) 131I-MIBG and 8 (25.8%) had received treatment with chemotherapy only. Subsequent DTC was detected by surveillance through neck palpation (46.2%), as a self-identified mass (34.6%), or by chance. Among sporadic DTC patients, self detection predominated (68.8%). CCS with subsequent DTC tended to have on average smaller tumors (1.9 vs 2.4 cm, respectively, (P = 0.051), and more often bilateral (5/25 (60.0%) vs 28/92 (30.4%), P = 0.024). There were no significant differences in the occurrence of surgical complications, recurrence rate or disease-related death. CONCLUSION When compared to patients with sporadic DTC, CCS with subsequent DTC seem to present with smaller tumors and more frequent bilateral tumors. Treatment outcome seems to be similar. The finding that one-third of subsequent DTC cases had been treated with chemotherapy only needs further investigation. These results are important for the development of surveillance programs for CCS at risk for DTC and for treatment guidelines of subsequent DTC.
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Affiliation(s)
- Sarah C Clement
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam University Medical Center location VU Medical Center, Amsterdam, The Netherlands
| | - Chantal A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Mariëlle S Klein Hesselink
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cecile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Medical University Brandenburg - Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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12
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van Iersel L, Clement SC, Schouten-van Meeteren AYN, Boot AM, Claahsen-van der Grinten HL, Granzen B, Sen Han K, Janssens GO, Michiels EM, van Trotsenburg ASP, Vandertop WP, van Vuurden DG, Caron HN, Kremer LCM, van Santen HM. Declining free thyroxine levels over time in irradiated childhood brain tumor survivors. Endocr Connect 2018; 7:1322-1332. [PMID: 30400062 PMCID: PMC6280587 DOI: 10.1530/ec-18-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/03/2022]
Abstract
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.
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Affiliation(s)
- Laura van Iersel
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah C Clement
- Department of Pediatrics, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Antoinette Y N Schouten-van Meeteren
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Annemieke M Boot
- Department of Pediatric Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hedi L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernd Granzen
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Sen Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erna M Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam and location VU University Medical Center, Amsterdam, The Netherlands
| | - Dannis G van Vuurden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatric Oncology/Hematology, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Hubert N Caron
- Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Correspondence should be addressed to H M van Santen:
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13
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Clement SC, Schouten-van Meeteren AY, Boot AM, Claahsen-van der Grinten HL, Granzen B, Sen Han K, Janssens GO, Michiels EM, van Trotsenburg AP, Vandertop WP, van Vuurden DG, Kremer LC, Caron HN, van Santen HM. Prevalence and Risk Factors of Early Endocrine Disorders in Childhood Brain Tumor Survivors: A Nationwide, Multicenter Study. J Clin Oncol 2016; 34:4362-4370. [DOI: 10.1200/jco.2016.67.5025] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah C. Clement
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Antoinette Y.N. Schouten-van Meeteren
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Annemieke M. Boot
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Hedy L. Claahsen-van der Grinten
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Bernd Granzen
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - K. Sen Han
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Geert O. Janssens
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Erna M. Michiels
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - A.S. Paul van Trotsenburg
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - W. Peter Vandertop
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Dannis G. van Vuurden
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Leontien C.M. Kremer
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Hubert N. Caron
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
| | - Hanneke M. van Santen
- Sarah C. Clement, K. Sen Han, and Hanneke M. van Santen, University Medical Center Utrecht, Utrecht; Sarah C. Clement, Antoinette Y.N. Schouten-van Meeteren, A.S. Paul van Trotsenburg, W. Peter Vandertop, Leontien C.M. Kremer, and Hubert N. Caron, Academic Medical Center, University of Amsterdam; W. Peter Vandertop and Dannis G. van Vuurden, Vrije Universiteit University Medical Center, Amsterdam; Annemieke M. Boot, University Medical Center Groningen, University of Groningen, Groningen; Hedy L. Claahsen
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Clement SC, Meeteren AYNSV, Kremer LCM, van Trotsenburg ASP, Caron HN, van Santen HM. High prevalence of early hypothalamic-pituitary damage in childhood brain tumor survivors: need for standardized follow-up programs. Pediatr Blood Cancer 2014; 61:2285-9. [PMID: 25131941 DOI: 10.1002/pbc.25176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/19/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Childhood brain tumor survivors (CBTS) are at increased risk to develop endocrine disorders. Alerted by two cases who experienced delay in diagnosis of endocrine deficiencies within the first 5 years after brain tumor diagnosis, our aim was to investigate the current screening strategy and the prevalence of endocrine disorders in survivors of a childhood brain tumor outside of the hypothalamic-pituitary region, within the first 5 years after diagnosis. PROCEDURES Firstly, we performed a retrospective study of 47 CBTS treated in our center, diagnosed between 2008 and 2012. Secondly, the literature was reviewed for the prevalence of endocrine disorders in CBTS within the first 5 years after diagnosis. RESULTS Of 47 CBTS eligible for evaluation, in 34% no endocrine parameters had been documented at all during follow up. In the other 66%, endocrine parameters had been inconsistently checked, with different parameters at different time intervals. In 19% of patients an endocrine disorder was found. At literature review 22 studies were identified. The most common reported endocrine disorder within the first 5 years after diagnosis was growth hormone deficiency (13-100%), followed by primary gonadal dysfunction (0-91%) central hypothyroidism (0-67%) and primary/subclinical hypothyroidism (range 0-64%). CONCLUSION Endocrine disorders are frequently seen within the first 5 years after diagnosis of a childhood brain tumor outside of the hypothalamic-pituitary region. Inconsistent endocrine follow up leads to unnecessary delay in diagnosis and treatment. Endocrine care for this specific population should be improved and standardized. Therefore, high-quality studies and evidence based guidelines are warranted.
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Affiliation(s)
- Sarah C Clement
- Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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15
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Clement SC, Kremer LCM, Links TP, Mulder RL, Ronckers CM, van Eck-Smit BLF, van Rijn RR, van der Pal HJH, Tissing WJE, Janssens GO, van den Heuvel-Eibrink MM, Neggers SJCMM, van Dijkum EJMN, Peeters RP, van Santen HM. Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis? Cancer Treat Rev 2014; 41:9-16. [PMID: 25544598 DOI: 10.1016/j.ctrv.2014.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/22/2014] [Accepted: 10/30/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is no international consensus on surveillance strategies for differentiated thyroid carcinoma (DTC) after radiotherapy for childhood cancer. Ultrasonography could allow for early detection of DTC, however, its value is yet unclear since the prognosis of DTC is excellent. We addressed the evidence for the question: 'is outcome of DTC influenced by tumor stage at diagnosis?'. METHODS A multidisciplinary working group answered the sub-questions: 'is recurrence or mortality influenced by DTC stage at diagnosis? Does detection of DTC at an early stage contribute to a decline in adverse events of treatment?' The literature was systematically reviewed, and conclusions were drawn based on the level of evidence (A: high, B: moderate to low, C: very low). RESULTS In children, level C evidence was found that detection of DTC at an early stage is associated with lower recurrence and mortality rates. No evidence was found that it influences morbidity rates. In adults, clear evidence was found that less advanced staged DTC is a favorable prognostic factor for recurrence (level B) and mortality (level A). Additionally, it was found that more extensive surgery increases the risk to develop transient hypoparathyroidism (level A) and that higher doses of radioiodine increases the risk to develop second primary malignancies (level B). CONCLUSION Identification of DTC at an early stage is beneficial for children (very low level evidence) and adults (moderate to high level evidence), even considering that the overall outcome is excellent. These results are an important cornerstone for the development of guidelines for childhood cancer survivors at risk for DTC.
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Affiliation(s)
- S C Clement
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - L C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands
| | - T P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - R L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - C M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands
| | - B L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - R R van Rijn
- Department of Radiology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - H J H van der Pal
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Oncology, Academic Medical Center, Amsterdam, University of Amsterdam, PO Box 22660 1100 DD Amsterdam, The Netherlands
| | - W J E Tissing
- Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - G O Janssens
- Department of Radiation Oncology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - M M van den Heuvel-Eibrink
- Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Pediatric Hematology and Oncology, Erasmus MC/Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands
| | - S J C M M Neggers
- Dutch Childhood Oncology Group (DCOG-LATER), PO Box 43515, 2504 AM The Hague, The Netherlands; Department of Internal Medicine/Endocrinology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - R P Peeters
- Department of Internal Medicine/Endocrinology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Rotterdam Thyroid Center, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital/University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands
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Clement SC, Kraal KCJM, van Eck-Smit BLF, van den Bos C, Kremer LCM, Tytgat GAM, van Santen HM. Primary ovarian insufficiency in children after treatment with 131I-metaiodobenzylguanidine for neuroblastoma: report of the first two cases. J Clin Endocrinol Metab 2014; 99:E112-6. [PMID: 24187404 DOI: 10.1210/jc.2013-3595] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary ovarian insufficiency (POI) is a noted late effect in childhood cancer survivors treated with alkylating agents or after radiation to a field that includes the ovaries. Gonadal failure in children with neuroblastoma (NBL) who were exposed to 131I- metaiodobenzylguanidine (MIBG) has only been reported in those who were also treated with chemotherapy. In these cases, the cause of gonadal failure was assumed to be the cytotoxic therapy. Here, we present the first two cases of POI after 131I-MIBG treatment only for NBL, indicating that 131I-MIBG treatment may have a causative role. PATIENTS During follow-up after treatment for NBL in childhood, elevated gonadotropins were found in a 12-year-old girl and an 11-year-old girl (FSH values, 105 and 161 U/L, respectively), indicating POI. The first patient had been diagnosed at the age of 17 months with sacrally located (intraspinal) NBL. Treatment consisted of five courses of 131I-MIBG and local resection. The second patient had been diagnosed at the age of 8 months with an abdominal (intraspinal) NBL. She had been treated with acute (neuro) surgery for decompression of her intraspinal tumor causing neurological symptoms, followed by two courses of 131I-MIBG therapy. Both girls had normal karyotypes (46, XX). No other cause for the ovarian failure was found. Estrogen suppletion was started, and patients and parents were counseled regarding fertility options. CONCLUSION These two cases suggest that exposure to 131I-MIBG may damage the female gonads. Clinicians caring for childhood cancer survivors should be aware of the risk of POI after 131I-MIBG treatment. Prospective studies are warranted to confirm our observations.
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Affiliation(s)
- S C Clement
- Departments of Pediatric Endocrinology (S.C.C., H.M.v.S.) and Pediatric Oncology (K.C.J.M.K., C.v.d.B., L.C.M.K., G.A.M.T.), Emma Children's Hospital, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; Department of Nuclear Medicine (B.L.F.v.E.-S.), Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; and Department of Pediatric Endocrinology (H.M.v.S.), Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
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Clement SC, van Eck-Smit BLF, van Trotsenburg ASP, Kremer LCM, Tytgat GAM, van Santen HM. Long-term follow-up of the thyroid gland after treatment with 131I-Metaiodobenzylguanidine in children with neuroblastoma: importance of continuous surveillance. Pediatr Blood Cancer 2013; 60:1833-8. [PMID: 23832530 DOI: 10.1002/pbc.24681] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/11/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Thyroid dysfunction has been reported in up to 52% of patients 1.4 years after treatment with (131) I-Metaiodobenzylguanidine (MIBG) in children with neuroblastoma (NBL), despite the use of potassium-iodide (KI). Our aim was to investigate if the incidence and severity of thyroid damage increases in time. MATERIALS AND METHODS All long-term survivors of childhood NBL treated with (131) I-MIBG in the period 1989-1999 in our center (n = 16 of 43) were evaluated. During exposure to (131) I-MIBG, patients received 100 mg KI per day as thyroid protection. All MIBG images were evaluated for thyroid uptake of radio-iodine. Thyroid dysfunction was defined as a plasma thyrotropin concentration above the institutional age-related reference ranges (thyrotropin elevation, TE) or using thyroxine at last moment of follow-up. In all, ultrasound investigation of the thyroid was performed. RESULTS Fifteen years after treatment with (131) I-MIBG, in 81% (n = 13) thyroid disorders were diagnosed. Eight survivors (50%) were treated with thyroxine. Thyroid nodules were found in nine survivors, of which two were diagnosed with papillary thyroid carcinoma. In 28% of (131) I-MIBG-images radio-iodine uptake in the thyroid gland was seen, but no correlation was found between thyroidal radio-iodine uptake and thyroid disorders. CONCLUSIONS Despite protection with KI during exposure to (131) I-MIBG in childhood, the occurrence of thyroid disorders is high and increases in time. Continuous screening for thyroid dysfunction and nodules in these survivors is recommended. Other ways to protect the thyroid gland should be further evaluated.
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Affiliation(s)
- S C Clement
- Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Bray GA, Smith SR, Banerji MA, Tripathy D, Clement SC, Buchanan TA, Henry RR, Kitabchi AE, Mudaliar S, Musi N, Ratner RE, Schwenke DC, Stentz FB, Reaven PD, DeFronzo RA. Effect of pioglitazone on body composition and bone density in subjects with prediabetes in the ACT NOW trial. Diabetes Obes Metab 2013; 15:931-7. [PMID: 23551856 DOI: 10.1111/dom.12099] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/26/2013] [Accepted: 03/14/2013] [Indexed: 01/08/2023]
Abstract
AIMS This study examined the effects of pioglitazone on body weight and bone mineral density (BMD) prospectively in patients with impaired glucose tolerance as pioglitazone (TZD) increases body weight and body fat in diabetic patients and increases the risk of bone fractures. METHODS A total of 71 men and 163 women aged 49.3 (10.7) years [mean (s.d.)]; body mass index (BMI), 34.5 (5.9) kg/m(2) were recruited at five sites for measurements of body composition by dual energy X-ray absorptiometry at baseline and at conversion to diabetes or study end, if they had not converted. RESULTS Mean follow-up was 33.6 months in the pioglitazone group and 32.1 months in the placebo group. Body weight increased 4.63 ± 0.60 (m ± s.e.) kg in the pioglitazone group compared to 0.98 ± 0.62 kg in the PIO group (p < 0.0001). Body fat rose 4.89 ± 0.42 kg in the pioglitazone group compared to 1.41 ± 0.44 kg, (p < 0.0001) in placebo-treated subjects. The increase in fat was greater in legs and trunk than in the arms. BMD was higher in all regions in men and significantly so in most. PIO decreased BMD significantly in the pelvis in men and women, decreased BMD in the thoracic spine and ribs of women and the lumbar spine and legs of men. Bone mineral content also decreased significantly in arms, legs, trunk and in the total body. CONCLUSIONS Pioglitazone increased peripheral fat more than truncal fat and decreased BMD in several regions of the body.
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Affiliation(s)
- G A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
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Pronk SM, Clement SC, Weijer O. [A newborn with tachypnea]. Ned Tijdschr Geneeskd 2013; 157:A3963. [PMID: 23406636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A neonate developed a tachypnea 2 hours after his birth. Blood measurements showed low infectious parameters and a respirator acidosis. The x-ray showed a pneumomediastinum. A spontaneous pneumomediastinum is rare in newborns, causes can be underlying lung diseases or mechanical ventilation. The treatment prognosis is good; spontaneous recovery without treatment is common.
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Abstract
Ectopic thyroid is rare and occasionally presents suddenly in childhood. Adult patients with thyroid ectopy who develop local symptoms commonly have an enlarged ectopic gland and hypothyroidism. We describe the first case of an adult patient who sudden presented with sudden dysphagia and dyspnea caused by a large lingual thyroid in clinical and biochemical euthyroidism. Treatment consisted of surgical removal of the ectopic gland and thyroid hormone replacement therapy.
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Affiliation(s)
- C A Koch
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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Koch CA, Azumi N, Furlong MA, Jha RC, Kehoe TE, Trowbridge CH, O'Dorisio TM, Chrousos GP, Clement SC. Carcinoid syndrome caused by an atypical carcinoid of the uterine cervix. J Clin Endocrinol Metab 1999; 84:4209-13. [PMID: 10566674 DOI: 10.1210/jcem.84.11.6126] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neuroendocrine tumors of the cervix are rare and are often under- or misdiagnosed. Because these tumors are very aggressive, early diagnosis and subsequent treatment are warranted. We describe a 46-yr-old woman with carcinoid syndrome caused by an atypical carcinoid of the uterine cervix. At age 44, she had dysplasia on Pap smear and underwent total abdominal hysterectomy with the diagnosis of adenocarcinoma. Fourteen months postoperatively, she developed the carcinoid syndrome and was found to have numerous liver metastases. Histological and immunohistochemical investigations of biopsy specimens from the patient's liver lesions and original cervical lesion ("adenocarcinoma") suggested that this woman had a primary atypical carcinoid of the uterine cervix with metastases to the liver. Treatment with octreotide and alkylating agents decreased the episodes of flushing and diarrhea within 8 weeks. If an adenocarcinoma of the uterine cervix is diagnosed, atypical carcinoid should be in the differential diagnosis. Symptoms of the carcinoid syndrome should be pursued and, if present, a urinary 5-hydroxyindolacetic acid level should be obtained. Timely diagnosis of a neuroendocrine tumor of the cervix may improve survival.
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Affiliation(s)
- C A Koch
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1862, USA
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Abstract
Rapid sequence intubation (RSI) has recently gained wide acceptance among emergency physicians (EP). The debate regarding the safety of neuromuscular blocking (NMB) agents in the hands of EPs nonetheless remains open, as objective studies are few, and all data available so far come from tertiary care centers. This retrospective study was done to review our experience with RSI and assess the related morbidity and mortality. Two hundred and nineteen intubations were done using an RSI protocol during the study period. Hypotension occurred in 24 patients. Two patients had a short run of bigeminy and 3 had bradycardia. One patient went into cardiac arrest unrelated to the use of a NMB agent. Aspiration was documented in 3 patients. All patients were successfully intubated. No mortality was attributed to the use of muscle relaxants. Our results support the safety and effectiveness of RSI in the hands of emergency physicians.
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Affiliation(s)
- D G Dufour
- Emergency Department, Hôpital du Haut-Richelieu, St-Jean-sur-le-Richelieu, Quebec, Canada
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Clement SC, Gay N. A better method for demonstrating the relationship between factors affecting glycemic control. Diabetes Educ 1992; 18:243-6. [PMID: 1451626 DOI: 10.1177/014572179201800313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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