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Review
. 2010 Sep;8(1):6-17.

Pediatric brain tumor treatment: growth consequences and their management

Sogol Mostoufi-Moab  1 , Adda Grimberg
Affiliations
Review

Pediatric brain tumor treatment: growth consequences and their management

Sogol Mostoufi-Moab et al. Pediatr Endocrinol Rev. 2010 Sep.

Abstract

Tumors of the central nervous system, the most common solid tumors of childhood, are a major source of cancer-related morbidity and mortality in children. Survival rates have improved significantly following treatment for childhood brain tumors, with this growing cohort of survivors at high risk of adverse medical and late effects. Endocrine morbidities are the most prominent disorder among the spectrum of longterm conditions, with growth hormone deficiency the most common endocrinopathy noted, either from tumor location or after cranial irradiation and treatment effects on the hypothalamic/pituitary unit. Deficiency of other anterior pituitary hormones can contribute to negative effects on growth, body image and composition, sexual function, skeletal health, and quality of life. Pediatric and adult endocrinologists often provide medical care to this increasing population. Therefore, a thorough understanding of the epidemiology and pathophysiology of growth failure as a consequence of childhood brain tumor, both during and after treatment, is necessary and the main focus of this review.

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Figures

Figure 1
Figure 1. GH system effects of craniospinal irradiation that decrease growth
Levels of all hormones are reduced. Normal growth hormone (GH) secretion is shown by the solid line; following irradiation by the dashed line. Decreased growth hormone releasing hormone (GHRH) secretion diminishes the growth hormone (GH) pulse amplitude and with time, leads to atrophy of the pituitary somatotrophs. Decreased somatostatin (ss) and insulin-like growth factor-1 (IGF-I) inhibition lead to enhanced tonic GH secretion by the remaining functional somatotrophs. Direct radiation injury to the thyroid and reduced thyroid stimulating hormone (TSH) secretion decrease thyroid hormone (T4) production, which further reduces GH secretion centrally and reduces growth plate responsiveness. Likewise, direct radiation injury to the spine decreases its growth response to GH.
See this image and copyright information in PMC

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