Height deficit and impairment of the GH/IGF-1 axis in patients treated for acute lymphoblastic leukemia during childhood

Abstract

Background: Endocrine complications after acute lymphoblastic leukemia (ALL) are common.

Methods: Final height, GH/IGF-1 axis, and body mass index were analyzed after 13.7 (7.0-20.7) years from diagnosis in 34 boys aged <12 years at diagnosis and 41 girls <10 years at diagnosis. A modified German BFM-83 ALL protocol included (n = 42) or did not include (n = 33) prophylactic cranial irradiation. In 27 patients, GH after insulin tolerance test, IGF-1, cortisol, free T(4) and estradiol/testosterone were determined.

Results: Final height was significantly reduced (mean Z-score for height between final height and diagnosis, ΔHAZ = -0.61, p = 0.0001). At that point, 3 patients were obese (4%) and 17 were overweight (22.7%). Patients aged ≤ 4 years at diagnosis and those irradiated had a greater loss in final height (p = 0.001 and p = 0.008, respectively). Abnormalities in GH/IGF-1 axis were observed in 4 patients: 3 had a GH peak <6 ng/ml and 1 had a serum IGF-1 concentration <25 ng/ml. Growth deficit was significantly higher in patients with hormonal deficiency (p = 0.006).

Conclusions: Treatment of ALL during childhood is associated with final height deficit. Young age at diagnosis and radiotherapy were the major risk factors. GH/IGF-1 deficiency was found particularly in irradiated patients, even though it was detected in 1 non-irradiated patient.