Prevalence and risk factors of radiation-induced growth hormone deficiency in childhood cancer survivors: A systematic review

2009 ◽  
Vol 35 (7) ◽  
pp. 616-632 ◽  
Author(s):  
Renée L. Mulder ◽  
Leontien C.M. Kremer ◽  
Hanneke M. van Santen ◽  
Jan Lucas Ket ◽  
A.S. Paul van Trotsenburg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Growth Hormone Deficiency ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Radiation Induced

Risk Factors for Small Adult Height in Childhood Cancer Survivors

2020 ◽  
Vol 38 (16) ◽  
pp. 1785-1796 ◽  
Author(s):  
Charlotte Demoor-Goldschmidt ◽  
Rodrigue S. Allodji ◽  
Neige Journy ◽  
Carole Rubino ◽  
Wael Salem Zrafi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Hormone ◽  
Standard Deviation ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Adult Height ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Health Study ◽  
Pituitary Irradiation

PURPOSE Between 10% and 20% of childhood cancer survivors (CCS) experience impaired growth, leading to small adult height (SAH). Our study aimed to quantify risk factors for SAH or growth hormone deficiency among CCS. METHODS The French CCS Study holds data on 7,670 cancer survivors treated before 2001. We analyzed self-administered questionnaire data from 2,965 CCS with clinical, chemo/radiotherapy data from medical records. SAH was defined as an adult height ≤ 2 standard deviation scores of control values obtained from a French population health study. RESULTS After exclusion of 189 CCS treated with growth hormone, 9.2% (254 of 2,776) had a SAH. Being young at the time of cancer treatment (relative risk [RR], 0.91 [95% CI, 0.88 to 0.95] by year of age), small height at diagnosis (≤ 2 standard deviation scores; RR, 6.74 [95% CI, 4.61 to 9.86]), pituitary irradiation (5-20 Gy: RR, 4.24 [95% CI, 1.98 to 9.06]; 20-40 Gy: RR, 10.16 [95% CI, 5.18 to 19.94]; and ≥ 40 Gy: RR, 19.48 [95% CI, 8.73 to 43.48]), having received busulfan (RR, 4.53 [95% CI, 2.10 to 9.77]), or > 300 mg/m2 of lomustine (300-600 mg/m2: RR, 4.21 [95% CI, 1.61 to 11.01] and ≥ 600 mg/m2: RR, 9.12 [95% CI, 2.75 to 30.24]) were all independent risk factors for SAH. Irradiation of ≥ 7 vertebrae (≥ 15 Gy on ≥ 90% of their volume) without pituitary irradiation increased the RR of SAH by 4.62 (95% CI, 2.77 to 7.72). If patients had also received pituitary irradiation, this increased the RR by an additional factor of 1.3 to 2.4. CONCLUSION CCS are at a high risk of SAH. CCS treated with radiotherapy, busulfan, or lomustine should be closely monitored for growth, puberty onset, and potential pituitary deficiency.

Growth hormone deficiency and cardiovascular risk factors in childhood cancer survivors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6614-6614
Author(s):  
K. Gujral ◽  
A. Petryk ◽  
L. Steffen ◽  
K. Baker ◽  
J. Perkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Visceral Fat ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Percent Body Fat ◽  
Cvd Risk Factors ◽  
Cvd Risk

6614 Background: Childhood cancer survivors (CCS) have a high frequency of growth hormone deficiency (GHD) and risk of early cardiovascular disease (CVD). This study examined the relations between GHD and risk factors for CVD in CCS. Methods: Anthropometrics, blood pressure, lipids, growth hormone (GH) stimulation test, dual-energy x-ray absorptiometry, abdominal CT, and insulin resistance (IR) (euglycemic, hyperinsulinemic clamp - low M/lbm signifies IR) were obtained in 174 CCS, mean age 15±2 years and 89 healthy sibling controls, mean age 13.5±3 years. Linear regression evaluated the relations between GHD and CVD risk factors, adjusted for sex, age, pubertal stage, and body mass index (BMI) or visceral fat. Results: 62 CCS (36%) had GHD. There were no significant measurement differences between non-GHD CCS and controls. Compared to controls, GHD CCS who never received GH (N = 34) had greater BMI (24.8 vs 20.8 kg/m2, p < 0.0001), percent body fat (36.1% vs 25.8%, p < 0.0001), visceral fat (34.8 vs 19.6 cm2, p < 0.0001), and triglycerides (TG) (120.2 vs 83.8 mg/dL, p = 0.001) and were more IR (M/lbm 11.1 vs 14.2 mg/kg/min, p = 0.0006). Adjustment for BMI and visceral fat did not change the IR or TG results. GHD CCS currently on GH had lower BMI (21.9 kg/m2, p = 0.02), percent body fat (31.2%, p = 0.08), and visceral fat (26.5 cm2, p = 0.03) compared to those not treated. IR and TG were not different between treated and not treated GHD CCS. Conclusions: GHD is a common finding in CCS and is significantly associated with adiposity, IR, and elevated TG.There is a suggestion that GH treatment had a positive impact on adiposity, but not IR and TG levels. These study findings imply that CVD risk factors are present in CCS with GHD independent of body fatness, suggesting that the cancer diagnosis or treatments received may lead to early cardiovascular disease in childhood cancer survivors. No significant financial relationships to disclose.

The Limited Screening Value of Insulin-Like Growth Factor-I in 610 Very Long Term Adult Survivors of Leukemia and Other Types of Childhood Cancer

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 506-506
Author(s):  
Karin Blijdorp ◽  
Marry M. van den Heuvel ◽  
Rob Pieters ◽  
Annemieke Boot ◽  
Aartjan van der Lely ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Body Mass ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Fat Percentage ◽  
Igf I ◽  
Z Scores

Abstract Abstract 506FN2 Introduction Over the last decades childhood cancer survival rates have improved significantly. Currently, 70–80% of patients become long term cancer survivors. It has been estimated that 1 out of 640 young adults in the U.S. is a survivor of childhood cancer. Consequently, the incidence of late, treatment-related complications is increasing. Endocrine sequelae, such as the metabolic syndrome, osteopenia, sub fertility, thyroid dysfunction and growth hormone deficiency represent an important category of such late effects. Growth hormone deficiency (GHD) in childhood cancer survivors, mainly caused by cranial radiotherapy, is reflected by low levels of insulin like growth factor 1 (IGF-I). Whereas the value of IGF-I measurement for the diagnosis of GHD is controversial, low IGF-I levels are associated with high body mass index and high visceral fat percentage. However the clinical relevance of low IGF-I levels in long term childhood cancer survivors is not extensively studied. In this study we evaluated whether IGF-I is useful as a marker for altered body composition and growth hormone deficiency in this group. Methods We retrospectively analyzed data of 610 adult childhood cancer survivors, retrieved from the Rotterdam late effects clinic, which starts 5 years after cessation of therapy. Median age at diagnosis was 6 years (interquartile range (IQR) 3–11) and follow up time was 18 years (13–24). We assessed IGF-I Z-scores, anthropometrical measures, growth hormone stimulation tests in patients with clinical suspicion of GHD and measures of body composition (assessed by dual X-ray absorptiometry, Lunar Prodigy). Results Cranial irradiated acute leukaemia survivors (25 Gy (24–25)) and locally irradiated brain tumour survivors (42 Gy (35–54)) had significantly lower IGF-I Z-scores (p<0.001), lower height SDS (p<0.001), higher body mass index (p=0.01), higher waist-hip ratio (p=0.001), higher visceral fat percentage (p<0.001), higher total fat percentage (p<0.001) and lower lean body mass (p<0.001), compared to non cranial irradiated survivors. IGF-I did not show a strong correlation with BMI (r=-0.12, p=0.04), waist hip ratio (r=-0.15, p=0.01), total fat percentage (r=-0.14, p=0.02) and lean body mass (r=0.15, p=0.01). In the patients with low IGF-I levels who had growth hormone stimulation, IGF-I Z-scores did not significantly differ between the patients with and without severe GHD (p = 0.39). Conclusion This study shows that there is a limited value of IGF-I as marker for alterations in body composition, and confirms the fact that low IGF-I levels are not predictive for GHD, in a large cohort of childhood cancer survivors. Therefore the use of IGF-I should not be encouraged in adult childhood cancer survivors. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Predictive Value of Insulin-Like Growth Factor 1 in Irradiation-Dependent Growth Hormone Deficiency in Childhood Cancer Survivors

2018 ◽  
Vol 90 (5) ◽  
pp. 314-325 ◽  
Author(s):  
Alessandro Cattoni ◽  
Enrico Clarke ◽  
Assunta Albanese
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Positive Predictive Value ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Predictive Value ◽  
Final Height ◽  
Childhood Cancer Survivors ◽  
Insulin Like Growth Factor ◽  
Radiation Induced

Background: The literature contains conflicting reports on the value of low insulin-like growth factor 1 (IGF-1) levels in predicting radiation-induced growth hormone (GH) deficiency (GHD) in childhood cancer survivors (CCS). These reports often involve small samples of patients who have received irradiation or mixed cohorts including non-irradiated subjects. Objective: We undertook an analysis of the predictive value of low IGF-1 in CCS at risk for GHD after cranial radiotherapy involving the hypothalamic-pituitary (HP) area in a large single-centre cohort. Methods: We performed a retrospective analysis on 158 CCS diagnosed with GHD between January 1, 2003 and October 31, 2017 and identified 117 patients who received radiation for tumours not direct ly involving the HP area. Results: In this cohort, IGF-1 levels <–2 standard deviation scores (SDS) had a sensitivity of 31.9% for GHD; however, they were statistically more frequent (p = 0.0023) and had a higher sensitivity (45.6%) among patients with severe GHD. At final height reassessment, IGF-1 <–2 SDS had a sensitivity of 35.0% for GHD, but a positive predictive value of 100%. Finally, pretreatment IGF-1 values showed no correlation with the number of impaired pituitary hormonal axes in patients with multiple pituitary deficiencies. Conclusions: IGF-1 levels <–2 SDS showed a low sensitivity at predicting radiation-induced GHD both in childhood and in adulthood, but a high positive predictive value for GH status at final height reassessment.

scholarly journals Growth Hormone Deficiency and Treatment in Childhood Cancer Survivors

2021 ◽  
Vol 12 ◽  
Author(s):  
Netanya I. Pollock ◽  
Laurie E. Cohen
Keyword(s):  
At Risk ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Gh Therapy ◽  
Increased Risk ◽  
History Of

Growth hormone (GH) deficiency is a common pituitary hormone deficiency in childhood cancer survivors (CCS). The identification, diagnosis, and treatment of those individuals at risk are important in order to minimize associated morbidities that can be ameliorated by treatment with recombinant human GH therapy. However, GH and insulin-like growth factor-I have been implicated in tumorigenesis, so there has been concern over the use of GH therapy in patients with a history of malignancy. Reassuringly, GH therapy has not been shown to increase risk of tumor recurrence. These patients have an increased risk for development of meningiomas, but this may be related to their history of cranial irradiation rather than to GH therapy. In this review, we detail the CCS who are at risk for GHD and the existing evidence on the safety profile of GH therapy in this patient population.

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