학술논문
Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors: Prevalence, Risk Factors and Long-Term Health Outcomes
CLINICAL RESEARCH ARTICLE
CLINICAL RESEARCH ARTICLE
Document Type
Academic Journal
Author
van lersel, Laura; Li, Zhenghong; Srivastava, Deo Kumar; Brinkman, Tara M.; Bjornard, Kari L.; Wilson, Carmen L.; Green, Daniel M.; Merchant, Thomas E.; Pui, Ching-Hon; Howell, Rebecca M.; Smith, Susan A.; Armstrong, Gregory T.; Hudson, Melissa M.; Robison, Leslie L.; Ness, Kirsten K.; Gajjar, Amar; Krull, Kevin R.; Sklar, Charles A.; van Santen, Hanneke M.; Chemaitilly, Wassim
Source
Journal of Clinical Endocrinology & Metabolism. December 2019, Vol. 104 Issue 12, p6101, 15 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Improvement in survival of children diagnosed with cancer and research demonstrating high rates of chronic disease in adult survivors of childhood cancer highlight the importance of characterizing clinical factors that [...]
Context: Data on hypothalamic-pituitary (HP) disorders in systematically evaluated childhood cancer survivors are limited. Objective: To describe prevalence, risk factors, and associated adverse health outcomes of deficiencies in GH deficiency (GHD), TSH deficiency (TSHD), LH/FSH deficiency (LH/FSHD), and ACTH deficiency (ACTHD), and central precocious puberty (CPP). Design: Retrospective with cross-sectional health outcomes analysis. Setting: Established cohort; tertiary care center. Patients: Participants (N = 3141; median age, 31.7 years) were followed for a median 24.1 years. Main Outcome Measure: Multivariable logistic regression was used to calculate ORs and 95% CIs for associations among HP disorders, tumor- and treatment-related risk factors, and health outcomes. Results: The estimated prevalence was 40.2% for GHD, 11.1% for TSHD, 10.6% for LH/FSHD, 3.2% for ACTHD, and 0.9% for CPP among participants treated with HP radiotherapy (n = 1089), and 6.2% for GHD, and 30 Gy for ACTHD), alkylating agents (GHD, LH/FSHD), intrathecal chemotherapy (GHD), hydrocephalus with shunt placement (GHD, LH/FSHD), seizures (TSHD, ACTHD), and stroke (GHD, TSHD, LH/FSHD, ACTHD). Adverse health outcomes independently associated with HP disorders included short stature (GHD, TSHD), severe bone mineral density deficit (GHD, LH/FSHD), obesity (LH/FSHD), frailty (GHD), impaired physical health-related quality of life (TSHD), sexual dysfunction (LH/FSHD), impaired memory, and processing speed (GHD, TSHD). Conclusion: HP radiotherapy, central nervous system injury, and, to a lesser extent, chemotherapy are associated with HP disorders, which are associated with adverse health outcomes. (J Clin Endocrinol Metab 104: 6101-6115, 2019)
Context: Data on hypothalamic-pituitary (HP) disorders in systematically evaluated childhood cancer survivors are limited. Objective: To describe prevalence, risk factors, and associated adverse health outcomes of deficiencies in GH deficiency (GHD), TSH deficiency (TSHD), LH/FSH deficiency (LH/FSHD), and ACTH deficiency (ACTHD), and central precocious puberty (CPP). Design: Retrospective with cross-sectional health outcomes analysis. Setting: Established cohort; tertiary care center. Patients: Participants (N = 3141; median age, 31.7 years) were followed for a median 24.1 years. Main Outcome Measure: Multivariable logistic regression was used to calculate ORs and 95% CIs for associations among HP disorders, tumor- and treatment-related risk factors, and health outcomes. Results: The estimated prevalence was 40.2% for GHD, 11.1% for TSHD, 10.6% for LH/FSHD, 3.2% for ACTHD, and 0.9% for CPP among participants treated with HP radiotherapy (n = 1089), and 6.2% for GHD, and 30 Gy for ACTHD), alkylating agents (GHD, LH/FSHD), intrathecal chemotherapy (GHD), hydrocephalus with shunt placement (GHD, LH/FSHD), seizures (TSHD, ACTHD), and stroke (GHD, TSHD, LH/FSHD, ACTHD). Adverse health outcomes independently associated with HP disorders included short stature (GHD, TSHD), severe bone mineral density deficit (GHD, LH/FSHD), obesity (LH/FSHD), frailty (GHD), impaired physical health-related quality of life (TSHD), sexual dysfunction (LH/FSHD), impaired memory, and processing speed (GHD, TSHD). Conclusion: HP radiotherapy, central nervous system injury, and, to a lesser extent, chemotherapy are associated with HP disorders, which are associated with adverse health outcomes. (J Clin Endocrinol Metab 104: 6101-6115, 2019)