ACCELERATED LOWER-EXTREMITY EPIPHYSEAL MATURATION IN A PREPUBERTAL, GROWTH HORMONE-DEFICIENT GIRL AFTER TREATMENT FOR SACRAL GANGLIONEUROBLASTOMA

We sought to determine the cause of short stature in a 9-year-old girl who was referred to the University of Texas M. D. Anderson Cancer Cen ter for evaluation of this condition. At 4 years of age she had been f ound to have a large epidural and presacral ganglioneuroblastoma and h ad received radiotherapy followed by surgical resection. Systemic chem otherapy (ifosphamide, vincristine, and dacarbazine for 10 courses) wa s followed by treatment with cis-retinoic acid until the child was 7 y ears and 4 months old. She has been disease free with no further treat ment for an additional 2 years. Decreased growth hormone (GH) secretio n was suggested by abnormal clonidine testing (peak GH 0.8 ng/ml), abn ormal arginine testing (peak GH 4.3 ng/ml) and delayed wrist bone age. Most abnormal was her skeletal survey; there was almost complete fusi on of the epiphyseal growth centers of both femora, proximal tibiae an d fibulae. The bones of the upper extremities and spine were normal. C omparison with the first skeletal survey confirmed that these leg bone abnormalities were clearly not present at the time of cancer diagnosi s 5 years earlier. Growth failure in this child resulted from accelera ted lower extremity epiphyseal maturation. This abnormality followed s uccessful multimodality therapy for cancer, which included prolonged a dministration of retinoic acid. We suggest that this agent contributed to the patient's skeletal complications.