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Vol. 80. Issue 6.
Pages 357-364 (01 June 2014)
Vol. 80. Issue 6.
Pages 357-364 (01 June 2014)
Original Article
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Endocrinological outcome in children and adolescents survivors of central nervous system tumours after a 5 year follow-up
Secuelas endocrinológicas en niños y adolescentes supervivientes de tumores del sistema nervioso central tras 5 años de seguimiento
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M. Güemes Hidalgoa, M.T. Muñoz Calvoa,b,c,d,��
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maitemunozcalvo@gmail.com

Corresponding author.
, L. Fuente Blancoa, C. Villalba Castañoa, G.A. Martos Morenoa,b,c,d, J. Argentea,b,c,d,��
Corresponding author
jesus.argente@uam.es

Corresponding author.
a Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
b Servicio de Pediatría, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
c Departamento de Pediatría, Universidad Autónoma de Madrid, Madrid, Spain
d Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
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Abstract
Introduction

Given the successful increase in survival rates with the current treatments for central nervous system tumours (CNST), survivors are at high risk for late adverse effects.

Purpose

To evaluate the endocrine sequelae in children with CNST according to the type of tumour and treatment received.

Patients and methods

A retrospective review of the clinical features, auxology, hormone determinations and imaging findings of 38 patients (36.8% females, 63.2% males) with CNST, with a minimum of 5 years follow-up, was performed.

Results

The mean age at diagnosis was 5.34±3.07 years, with 76.3% of the patients having at least one hormone deficiency, of which growth hormone (GH) (73.7% of all patients) was the most prevalent, followed by thyrotropin (TSH) (68.4%), corticotropin (31.6%), antidiuretic hormone (28.9%), and gonadotropin (LH/FSH) (21.1%) deficiency. Precocious puberty was found in 21.1% of patients. After 5 years of follow-up, 28.9% were obese. Craniopharyngioma had more hormone deficiency, obesity and recurrence rates. The most frequently administered treatment was surgery + chemotherapy + radiotherapy, in 47.4% of the patients. Mean fi height (20 patients) was -1.2 1.6 SDS, with a mean difference of -0.53 SDS regarding their target height.

Conclusions

1) The type of tumour and treatment received influence the endocrinological sequelae. 2) The most frequent hormone deficiencies in all types of CNST, regardless of the treatment received, were GH and TSH. 3) Early diagnosis and prompt intervention of endocrine dysfunction can reduce the morbidity and improve quality of life over the long term.

Keywords:
Childhood brain tumours
Endocrine late effects
Hypothalamic pituitary axis
Cancer survivors
Resumen
Introducción

Con las terapias actuales, la supervivencia de los tumores del sistema nervioso central (TSNC) es cada vez mayor y, con ello, las complicaciones a largo plazo.

Objetivo

Evaluar las secuelas endocrinológicas en niños con TSNC en relación con el tipo de neoplasia y el tratamiento recibido.

Sujetos y métodos

Se revisaron retrospectivamente los datos clínicos, auxológicos, analíticos y radiológicos de 38 pacientes (36,8% mujeres y 63,2% varones) con antecedente de TSNC y seguimiento mínimo de 5 años.

Resultados

La media ± desviación estándar de edad al diagnóstico fue de 5,34 ± 3,07 años. El 76,3% de los casos presentó al menos un déficit hormonal, siendo el más prevalente el de hormona de crecimiento (GH) (73,7%), seguido de los déficits de tirotropina (TSH) (68,4%), corticotropina (31,6%), hormona antidiurética (28,9%) y gonadotropinas (LH/FSH) (21,1%). El 21,1% de los pacientes presentaron pubertad precoz. A los 5 años de seguimiento, el 28,9% presentaba obesidad. El craneofaringioma fue el tipo tumoral que registró mayor número de casos con deficiencias hormonales, obesidad y tasa de recurrencia. El tratamiento más frecuentemente administrado fue la combinación de cirugía + quimioterapia + radioterapia, empleado en el 47,4% de los pacientes. La talla final media ± desviación estándar (20 pacientes) fue −1,2 ± 1,6; con una disminución media de −0,53 DE respecto de su talla diana.

Conclusiones

1) El tipo tumoral y el tratamiento recibido influyen sobre las secuelas endocrinológicas; 2) las deficiencias hormonales más frecuentes en todos los tipos de TSNC, independientemente del tratamiento recibido, fueron GH y TSH; 3) el diagnóstico precoz y la intervención temprana sobre la disfunción endocrina, reducen la morbilidad y mejoran la calidad de vida a largo plazo.

Palabras clave:
Tumores cerebrales infantiles
Secuelas endocrinas
Eje hipotálamo-hipofisario
Supervivientes de cáncer
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Previous presentation of the work: certain aspects of this research were presented as a poster at the 51st Annual Meeting of the European Society of Paediatric Endocrinology (ESPE), held in Leipzig (Germany) held 20-23 September 2012. The authors and title of this communication were: Güemes M, Fuente L, Caballero FJ, Martos-Moreno G, Muñoz-Calvo MT, Argente J. Endocrinological effects in survivors of central nervous system tumours after a 5 year follow-up”.

Please cite this article as: Güemes Hidalgo M, Muñoz Calvo MT, Fuente Blanco L, Villalba Castaño C. Martos Moreno GA, Argente J. Secuelas endocrinológicas en niños y adolescentes supervivientes de tumores del sistema nervioso central tras 5 años de seguimiento. An Pediatr (Barc). 2014;80:357-364.

Copyright © 2013. Asociación Española de Pediatría
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