Preirradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function

Thomas E. Merchant, Tani Williams, Julie M. Smith, Susan R. Rose, Robert K. Danish, George A. Burghen, Larry E. Kun, Robert H. Lustig

Research output: Contribution to journalArticle

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Abstract

Purpose: To prospectively evaluate pediatric patients with localized primary brain tumors for evidence of endocrinopathy before radiotherapy (RT). Methods and Materials: Seventy-five pediatric patients were evaluated with the arginine tolerance test and L-dopa test for growth hormone secretory capacity and activity; thyroid-stimulating hormone surge and thyrotropin-releasing hormone stimulation test for the hypothalamic-thyroid axis; the 1-μg adrenocorticotropin hormone (ACTH) and metyrapone test for ACTH reserve; and, depending on age, a gonadotropin-releasing hormone stimulation test to determine gonadotropin response. The study included 38 male and 37 female patients, age 1-21 years with ependymoma (n = 35), World Health Organization (WHO) Grade I-II astrocytoma (n = 18), WHO Grade III-IV astrocytoma (n = 10), craniopharyngioma (n = 7), optic pathway tumor (n = 4), and germinoma (n = 1). Seven patients receiving dexamethasone at the time of the evaluation were excluded from the final analysis. Results: Of 68 assessable patient, 45 (66%) had evidence of endocrinopathy before RT, including 15 of 32 patients (47%) with posterior fossa tumors. Of the 45 patients, 38% had growth hormone deficiency, 43% had thyroid-stimulating hormone secretion abnormality, 22% had an abnormality in ACTH reserve, and 13% had an abnormality in age-dependent gonadotropin secretion. Conclusion: The incidence of pre-RT endocrinopathy in pediatric brain tumor patients is high, including patients with tumors not adjacent to the hypothalamic-pituitary unit. These data suggest an overestimation in the incidence of radiation-induced endocrinopathy. Baseline endocrine function should be determined for brain tumor patients before therapy. The potential for radiation-induced endocrinopathy alone cannot be used as an argument for alternatives to RT for most patients. Pre-RT endocrinopathy may be an early indicator of central nervous system damage that will influence the functional outcome unrelated to RT.

Original languageEnglish (US)
Pages (from-to)45-50
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume54
Issue number1
DOIs
StatePublished - Sep 1 2002

Fingerprint

dynamic tests
Brain Neoplasms
brain
tumors
hormones
Pediatrics
radiation therapy
adrenocorticotropin (ACTH)
Radiotherapy
Astrocytoma
abnormalities
pituitary hormones
Adrenocorticotropic Hormone
secretions
releasing
Hormones
Thyrotropin
Gonadotropins
stimulation
Growth Hormone

Keywords

  • Abnormalities
  • Astrocytoma
  • Brain neoplasms
  • Craniopharyngioma
  • Endocrinology
  • Ependymoma
  • Pediatrics
  • Radiation-induced

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Preirradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function. / Merchant, Thomas E.; Williams, Tani; Smith, Julie M.; Rose, Susan R.; Danish, Robert K.; Burghen, George A.; Kun, Larry E.; Lustig, Robert H.

In: International Journal of Radiation Oncology Biology Physics, Vol. 54, No. 1, 01.09.2002, p. 45-50.

Research output: Contribution to journalArticle

Merchant, Thomas E. ; Williams, Tani ; Smith, Julie M. ; Rose, Susan R. ; Danish, Robert K. ; Burghen, George A. ; Kun, Larry E. ; Lustig, Robert H. / Preirradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function. In: International Journal of Radiation Oncology Biology Physics. 2002 ; Vol. 54, No. 1. pp. 45-50.
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abstract = "Purpose: To prospectively evaluate pediatric patients with localized primary brain tumors for evidence of endocrinopathy before radiotherapy (RT). Methods and Materials: Seventy-five pediatric patients were evaluated with the arginine tolerance test and L-dopa test for growth hormone secretory capacity and activity; thyroid-stimulating hormone surge and thyrotropin-releasing hormone stimulation test for the hypothalamic-thyroid axis; the 1-μg adrenocorticotropin hormone (ACTH) and metyrapone test for ACTH reserve; and, depending on age, a gonadotropin-releasing hormone stimulation test to determine gonadotropin response. The study included 38 male and 37 female patients, age 1-21 years with ependymoma (n = 35), World Health Organization (WHO) Grade I-II astrocytoma (n = 18), WHO Grade III-IV astrocytoma (n = 10), craniopharyngioma (n = 7), optic pathway tumor (n = 4), and germinoma (n = 1). Seven patients receiving dexamethasone at the time of the evaluation were excluded from the final analysis. Results: Of 68 assessable patient, 45 (66{\%}) had evidence of endocrinopathy before RT, including 15 of 32 patients (47{\%}) with posterior fossa tumors. Of the 45 patients, 38{\%} had growth hormone deficiency, 43{\%} had thyroid-stimulating hormone secretion abnormality, 22{\%} had an abnormality in ACTH reserve, and 13{\%} had an abnormality in age-dependent gonadotropin secretion. Conclusion: The incidence of pre-RT endocrinopathy in pediatric brain tumor patients is high, including patients with tumors not adjacent to the hypothalamic-pituitary unit. These data suggest an overestimation in the incidence of radiation-induced endocrinopathy. Baseline endocrine function should be determined for brain tumor patients before therapy. The potential for radiation-induced endocrinopathy alone cannot be used as an argument for alternatives to RT for most patients. Pre-RT endocrinopathy may be an early indicator of central nervous system damage that will influence the functional outcome unrelated to RT.",
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AU - Rose, Susan R.

AU - Danish, Robert K.

AU - Burghen, George A.

AU - Kun, Larry E.

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N2 - Purpose: To prospectively evaluate pediatric patients with localized primary brain tumors for evidence of endocrinopathy before radiotherapy (RT). Methods and Materials: Seventy-five pediatric patients were evaluated with the arginine tolerance test and L-dopa test for growth hormone secretory capacity and activity; thyroid-stimulating hormone surge and thyrotropin-releasing hormone stimulation test for the hypothalamic-thyroid axis; the 1-μg adrenocorticotropin hormone (ACTH) and metyrapone test for ACTH reserve; and, depending on age, a gonadotropin-releasing hormone stimulation test to determine gonadotropin response. The study included 38 male and 37 female patients, age 1-21 years with ependymoma (n = 35), World Health Organization (WHO) Grade I-II astrocytoma (n = 18), WHO Grade III-IV astrocytoma (n = 10), craniopharyngioma (n = 7), optic pathway tumor (n = 4), and germinoma (n = 1). Seven patients receiving dexamethasone at the time of the evaluation were excluded from the final analysis. Results: Of 68 assessable patient, 45 (66%) had evidence of endocrinopathy before RT, including 15 of 32 patients (47%) with posterior fossa tumors. Of the 45 patients, 38% had growth hormone deficiency, 43% had thyroid-stimulating hormone secretion abnormality, 22% had an abnormality in ACTH reserve, and 13% had an abnormality in age-dependent gonadotropin secretion. Conclusion: The incidence of pre-RT endocrinopathy in pediatric brain tumor patients is high, including patients with tumors not adjacent to the hypothalamic-pituitary unit. These data suggest an overestimation in the incidence of radiation-induced endocrinopathy. Baseline endocrine function should be determined for brain tumor patients before therapy. The potential for radiation-induced endocrinopathy alone cannot be used as an argument for alternatives to RT for most patients. Pre-RT endocrinopathy may be an early indicator of central nervous system damage that will influence the functional outcome unrelated to RT.

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