Changes in Endocrine Function with Treatment of Intracranial Germ Cell Tumor

Lim, J S; Hwang, J S; Kim, S Y; Sim, K S; Shin, C H; Yang, S W; Hwang, Y S; Ahn, H S

Abstract

PURPOSE: We observed changes in the pituitary function before and after treatment and followed up on the weight and height after treatment in children with intracranial germ cell tumor.
METHODS
Initial clinical symptoms, and pituitary functions before and after treatment were reviewed in 33 children (21 male and 12 female, mean age; 12yr) with intracranial germ cell tumor. We also observed the changes in growth velocity, height standard deviation score (SDS) and body mass index (BMI).
RESULTS
The initial endocrine symptoms included polyuria in 21 patients (64%) and poor growth in 5 patients (15%). Forty-one percent revealed secondary hypothyroidism before treatment. After treatment, another 5 cases developed diabetes insipidus with recovery from diabetes insipidus in four patients after 4.5 years of treatment. Post-treatment pituitary function tests revealed GH deficiency in 94%, ACTH deficiency in 63%, TSH deficiency in 69%, and LH/FSH in 75%. Growth velocity decreased by 2.1cm/year, 3.7cm/year and 3.0cm/year during the 1st, 2nd and 3rd year after treatment, respectively. Height SDS significantly decreased from -0.75 before treatment to -1.09, -1.24 and -1.68 at 1st, 2nd and 3rd year after treatment, respectively (P<0.05) without change in BMI.
CONCLUSION
The pituitary function should be evaluated in children with intracranial germ cell tumor because a large proportion of patients revealed abnormal pituitary function. In contrast to the results in children with craniopharyngioma, the growth velocity after treatment of intracranial germ cell tumor decreased gradually without any change in BMI, probably because of the tumor characters, tumor locations, and radiation therapy to the spine.