All issues > Volume 49(3); 2006

Original Article

Korean J Pediatr. 2006;49(3):292-297. Published online March 15, 2006.

Endocrine dysfunction and growth in children with medulloblastoma

In Suk IS Yoon¹, Ji Young JY Seo¹, Choong Ho CH Shin¹, Il Han IH Kim², Hee Young HY Shin¹, Sei Won SW Yang¹, Hyo Seop HS Ahn¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence Choong Ho CH Shin ,Email: chshinpd@snu.ac.kr

Abstract

Purpose
: In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes.
Methods
: The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr.
Results
: The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from -0.1¡¾1.3 initially to -0.6¡¾1.0 after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency.
Conclusion
: Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.

Keywords :Medulloblastoma , Growth failure , Hypothyroidism , Hypogonadism , Radiation therapy