Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/0971-5851.113396
Radiation-induced hypopituitarism in children with acute lymphoblastic leukemia
![](https://www.thieme-connect.de/media/10.1055-s-00050348/201301/lookinside/thumbnails/10_4103_0971-5851_113396_8-1.jpg)
Abstract
Background: Acute Lymphoblastic Leukemia (ALL) is the most common malignancy among children for whom radiotherapy and chemotherapy are used for treatment. When hypothalamus-pituitary axis is exposed to radiotherapy, children′s hormone level and quality of life are influenced. The aim of this study is to determine late effects of radiotherapy on hormonal level in these patients. Materials and Methods: In this study 27 children with ALL, who have been referred to Shahid Ramezanzadeh Radiation Oncology Center in Yazd-Iran and received 18-24 Gy whole brain radiation with Cobalt 60 or 9 MV linear accelerator, were assessed. These patient′s basic weight, height and hormonal levels were measured before radiotherapy and also after different periods of time. Results: GHD (growth hormone deficiency) after clonidine stimulation test was observed in 44% (n=12) and that in 50% of them (n =6), less than 1 year, had been passed from their radiation therapy. None of these patients demonstrated hormone deficiency in other axes. Conclusions: This study showed that even application of a 18-24 Gy radiation dose might influence growth hormone levels; therefore, we recommend reduction of radiotherapy dose in such patients whenever possible.
Publication History
Article published online:
20 July 2021
© 2013. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Mandel K, Atkinson S, Barr RD, Pencharz P. Skeletal morbidity in childhood acute lymphoblastic leukemia. J Clin Oncol 2004;22:1215-21.
- 2 Warner JT, Evans WD, Webb DK, Bell W, Gregory JW. Relative osteopenia after treatment for acute lymphoblastic leukemia. Pediatr Res 1999;45:544-51.
- 3 Darzy KH, Shalet SM. Hypopituitarism following radiotherapy. Pituitary 2009;12:40-50.
- 4 Darzy KH. Radiation-induced hypopituitarism after cancer therapy: Who, how and when to test. Nat Clin Pract Endocrinol Metab 2009;5:88-99.
- 5 Fernandez A, Brada M, Zabuliene L, Karavitaki N, Wass JA. Radiation-induced hypopituitarism. Endocr Relat Cancer 2009;16:733-72.
- 6 Williams Textbook of Endocrinology. 11 th ed. Saunders: 2008. P. 239.
- 7 Thames HD, Hendry JH. Response of tissues to fractionated irradiation: Effect of repair, in fractionation in radiotherapy. London: Taylor and Francis; 1987. p. 53-99.
- 8 Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML. Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 1989;70:145-60.
- 9 Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, et al. Association between premature mortality and hypopituitarism. West midlands prospective hypopituitary study group. Lancet 2001;357:425-31.
- 10 Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, et al. Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 1993;328:87-94.
- 11 Brennan BM, Rahim A, Mackie EM, Eden OB, Shalet SM. Growth hormone status in adults treated for acute lymphoblastic leukaemia in childhood. Clin Endocrinol (Oxf) 1998;48:777-83.
- 12 Shalet SM, Beardwell CG, Pearson D, Jones PH. The effect of varying doses of cerebral irradiation on growth hormone production in childhood. Clin Endocrinol (Oxf) 1976;5:287-90.
- 13 Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ. HyposCCS Advisory Board; U.S. HypoCCS Study Group. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab 2002;87:477-85.
- 14 Biller BM, Samuels MH, Zagar A, Cook DM, Arafah BM, Bonert V, et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab 2002;87:2067-79.
- 15 Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML. Endocrine Society′s Clinical Guidelines Subcommittee, Stephens PA. Evaluation and treatment of adult growth hormone deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2006;91:1621-34.
- 16 Brouwer CA, Gietema JA, Kamps WA, de Vries EG, Postma A. Changes in body composition after childhood cancer treatment: Impact on future health status - a review. Crit Rev Oncol Hematol 2007;63:32-46.
- 17 Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006;355:1572-82.
- 18 Harz KJ, Müller HL, Waldeck E, Pudel V, Roth C. Obesity in patients with craniopharyngioma: Assessment of food intake and movement counts indicating physical activity. J Clin Endocrinol Metab 2003;88:5227-31.
- 19 Reilly JJ, Ventham JC, Newell J, Aitchison T, Wallace WH, Gibson BE. Risk factors for excess weight gain in children treated for acute lymphoblastic leukaemia. Int J Obes Relat Metab Disord 2000;24:1537-41.