Endocrine Dysfunction Following Treatment of Medulloblastoma

Song, C K; Lee, S Y; Jung, M H; Song, JY; Lee, K; Lee, K H; Hwang, J S; Shin, H Y; Yang, S W; Ahn, H S

Abstract

PURPOSE
We observed the changes in growth and endocrine dysfunction following surgery, craniospinal irradiation and chemotherapy for medulloblatoma.
METHODS
The medical records of 26 patients aged 1.7-15 year at the time of treatment for medulloblastma were reviewed. Thyroid function was assessed by measuring T4 or free T4, thyroxine and TSH concentrations in all patient. Combined anterior pituitary hormone provocation tests and growth hormone provocation tests were performed in 12 patients after cessation of irradiation and chemotherapy. Growth and pubertal changes were followed up before and after treatment.
RESULTS
:12 patients(46%) revealed primary thyroid dysfunction including primary hypothyroidism and compensated hypothyroidism. Growth hormone deficiency existed in 10 patients(38%) which was the most common hypothalamo-pituitary dysfunction. One girl with GHD had hyperprolactinemia, hypogonadotropic hypogonadism and ACTH deficiency and another boy had aymptomatic hyperprolactinemia. Primary gonadal dysfunction was noticed in two patients(8%) and secondary amenorrhea had developed in one of them. Mean height SDS decreased significantly from -0.19 before treatment to -1.71 after treatment of medulloblastoma(P=0.001).
CONCLUSION
Growth impairment and multiple endocrine dysfuncion, including hypothalamus or pituitary gland, thyroid gland and gonad, are common complications following treatment for medulloblastoma. Especially, development of primary thyroid dysfunction should be followed up in patients with medulloblastoma after craniospinal irradiation. This study confirmed the importance of regular follow-up for endocrine problem in survivors from medulloblastoma.