Growth failure after treatment of pediatric brain tumors

Objectives. Primary brain tumors are the most common solid tumors that occu r in childhood. With improved management of these tumors, there are more su rvivors with long-term sequelae of radiation and chemotherapy including gro wth failure. The aim of this study was to assess growth prospectively in ch ildren with nonpituitary-related primary brain tumors. Methods. Forty-one children 3.1 to 13.8 years of age diagnosed consecutivel y between 1989 and 1992 with a primary nonpituitary-related brain tumor wer e studied. Results. Of 34 prepubertal children, 14 (41%) were diagnosed as having grow th hormone (GH) deficiency. All 14 children were treated with cranial irrad iation. During the first year from completion of brain tumor therapy, the a nnual height velocity of those children confirmed subsequently as being GH- deficient was 3.06 +/- 1.19 cm compared with 5.29 +/- 2.21 cm for those who were not GH-deficient. During the second year, the annual height velocity was 3.29 +/- 1.14 cm per year for the GH-deficient group compared with 5.48 +/- 1.24 cm per year for the non-GH-deficient group. All children with GH deficiency received cranial irradiation and chemotherapy. Two of 34 childre n developed precocious puberty. Primary hypothyroidism was diagnosed in 6 o f 41 children (12%). Conclusion. We conclude that GH deficiency and primary hypothyroidism are c ommon after cranial irradiation and chemotherapy for nonpituitary-related b rain tumors. Linear growth appears to reflect GH status accurately in child ren with brain tumors. Precise auxologic evaluation is simple and noninvasi ve and may reflect more accurately GH status than provocative GH testing. T hese findings reflect the need for prospective growth monitoring of childre n with nonpituitary-related brain tumors treated with cranial irradiation a nd chemotherapy. Early diagnosis of GH deficiency facilitates early initiat ion of GH therapy and optimization of final height.