scholarly journals Growth Hormone Deficiency and Treatment in Childhood Cancer Survivors

2021 ◽  
Vol 12 ◽  
Author(s):  
Netanya I. Pollock ◽  
Laurie E. Cohen
Keyword(s):  
At Risk ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Gh Therapy ◽  
Increased Risk ◽  
History Of

Growth hormone (GH) deficiency is a common pituitary hormone deficiency in childhood cancer survivors (CCS). The identification, diagnosis, and treatment of those individuals at risk are important in order to minimize associated morbidities that can be ameliorated by treatment with recombinant human GH therapy. However, GH and insulin-like growth factor-I have been implicated in tumorigenesis, so there has been concern over the use of GH therapy in patients with a history of malignancy. Reassuringly, GH therapy has not been shown to increase risk of tumor recurrence. These patients have an increased risk for development of meningiomas, but this may be related to their history of cranial irradiation rather than to GH therapy. In this review, we detail the CCS who are at risk for GHD and the existing evidence on the safety profile of GH therapy in this patient population.

Managing childhood cancer survivors at risk for stroke: Practice norms and areas of controversy.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 124-124 ◽  
Author(s):  
Lisa Brazzamano Kenney ◽  
Bethany Ames ◽  
Alexis L. Michaud ◽  
David Williams ◽  
Nicole A. Ullrich ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Survivors ◽  
Acute Stroke ◽  
Childhood Cancer ◽  
Stroke Prevention ◽  
Childhood Cancer Survivors ◽  
Large Vessel ◽  
Small Vessel ◽  
Clinical Scenarios ◽  
Increased Risk

124 Background: Childhood cancer survivors (CCS) treated with cranial radiation (CR) are at increased risk for stroke. There is no evidence to guide stroke prevention strategies for CSS. We aimed to describe regional practice norms for managing survivors at risk for stroke and to define areas where management is controversial. Methods: We conducted a Delphi panel of 30 physicians from the New England region who care for CCS, including primary care and specialists. Panelists anonymously answered 3 rounds of open ended questionnaires querying their management approach to a childhood brain tumor survivor treated with CR formatted as 5 clinical scenarios (asymptomatic, large and small vessel cerebral vascular disease (CVD), TIA, stroke), covering 5 categories of management (imaging, lab testing, medication, counseling, referrals). Consensus was defined as ≥ 90% of panelist agreeing with management option. Results: There was a 100% response rate for all 3 rounds of questionnaires. Of the 25 management questions related to 5 clinical scenarios, consensus was reached on 18 while 7 remained controversial. In the scenario of acute stroke symptoms, consensus was reached in all 5 categories of management. In the scenarios of large vessel CVD with symptoms of a TIA, large-vessel CVD without symptoms, and small-vessel CVD without symptoms panelists did not reach consensus on medication, specifically, aspirin use. The primary reasons for disagreement were no evidence for benefit/risk and beyond area of expertise. In the scenario of an asymptomatic survivor with no history of CVD panelists did not reach consensus on indication for MRI surveillance imaging, the primary reasons for disagreement were no clear benefit and risk of findings with uncertain clinical significance. Consensus was not reached on specialty referral patterns in any scenario except acute stroke. Conclusions: Despite lack of evidence to guide stroke prevention in childhood cancer survivors treated with CR, a panel of regional physicians reached consensus on managing most clinical scenarios. Controversial areas requiring further study are follow-up imaging for asymptomatic survivors, aspirin for stroke prophylaxis, and indications for sub-specialty referral.

The Limited Screening Value of Insulin-Like Growth Factor-I in 610 Very Long Term Adult Survivors of Leukemia and Other Types of Childhood Cancer

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 506-506
Author(s):  
Karin Blijdorp ◽  
Marry M. van den Heuvel ◽  
Rob Pieters ◽  
Annemieke Boot ◽  
Aartjan van der Lely ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Body Mass ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Fat Percentage ◽  
Igf I ◽  
Z Scores

Abstract Abstract 506FN2 Introduction Over the last decades childhood cancer survival rates have improved significantly. Currently, 70–80% of patients become long term cancer survivors. It has been estimated that 1 out of 640 young adults in the U.S. is a survivor of childhood cancer. Consequently, the incidence of late, treatment-related complications is increasing. Endocrine sequelae, such as the metabolic syndrome, osteopenia, sub fertility, thyroid dysfunction and growth hormone deficiency represent an important category of such late effects. Growth hormone deficiency (GHD) in childhood cancer survivors, mainly caused by cranial radiotherapy, is reflected by low levels of insulin like growth factor 1 (IGF-I). Whereas the value of IGF-I measurement for the diagnosis of GHD is controversial, low IGF-I levels are associated with high body mass index and high visceral fat percentage. However the clinical relevance of low IGF-I levels in long term childhood cancer survivors is not extensively studied. In this study we evaluated whether IGF-I is useful as a marker for altered body composition and growth hormone deficiency in this group. Methods We retrospectively analyzed data of 610 adult childhood cancer survivors, retrieved from the Rotterdam late effects clinic, which starts 5 years after cessation of therapy. Median age at diagnosis was 6 years (interquartile range (IQR) 3–11) and follow up time was 18 years (13–24). We assessed IGF-I Z-scores, anthropometrical measures, growth hormone stimulation tests in patients with clinical suspicion of GHD and measures of body composition (assessed by dual X-ray absorptiometry, Lunar Prodigy). Results Cranial irradiated acute leukaemia survivors (25 Gy (24–25)) and locally irradiated brain tumour survivors (42 Gy (35–54)) had significantly lower IGF-I Z-scores (p<0.001), lower height SDS (p<0.001), higher body mass index (p=0.01), higher waist-hip ratio (p=0.001), higher visceral fat percentage (p<0.001), higher total fat percentage (p<0.001) and lower lean body mass (p<0.001), compared to non cranial irradiated survivors. IGF-I did not show a strong correlation with BMI (r=-0.12, p=0.04), waist hip ratio (r=-0.15, p=0.01), total fat percentage (r=-0.14, p=0.02) and lean body mass (r=0.15, p=0.01). In the patients with low IGF-I levels who had growth hormone stimulation, IGF-I Z-scores did not significantly differ between the patients with and without severe GHD (p = 0.39). Conclusion This study shows that there is a limited value of IGF-I as marker for alterations in body composition, and confirms the fact that low IGF-I levels are not predictive for GHD, in a large cohort of childhood cancer survivors. Therefore the use of IGF-I should not be encouraged in adult childhood cancer survivors. Disclosures: No relevant conflicts of interest to declare.

Risk Factors for Small Adult Height in Childhood Cancer Survivors

2020 ◽  
Vol 38 (16) ◽  
pp. 1785-1796 ◽  
Author(s):  
Charlotte Demoor-Goldschmidt ◽  
Rodrigue S. Allodji ◽  
Neige Journy ◽  
Carole Rubino ◽  
Wael Salem Zrafi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Hormone ◽  
Standard Deviation ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Adult Height ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Health Study ◽  
Pituitary Irradiation

PURPOSE Between 10% and 20% of childhood cancer survivors (CCS) experience impaired growth, leading to small adult height (SAH). Our study aimed to quantify risk factors for SAH or growth hormone deficiency among CCS. METHODS The French CCS Study holds data on 7,670 cancer survivors treated before 2001. We analyzed self-administered questionnaire data from 2,965 CCS with clinical, chemo/radiotherapy data from medical records. SAH was defined as an adult height ≤ 2 standard deviation scores of control values obtained from a French population health study. RESULTS After exclusion of 189 CCS treated with growth hormone, 9.2% (254 of 2,776) had a SAH. Being young at the time of cancer treatment (relative risk [RR], 0.91 [95% CI, 0.88 to 0.95] by year of age), small height at diagnosis (≤ 2 standard deviation scores; RR, 6.74 [95% CI, 4.61 to 9.86]), pituitary irradiation (5-20 Gy: RR, 4.24 [95% CI, 1.98 to 9.06]; 20-40 Gy: RR, 10.16 [95% CI, 5.18 to 19.94]; and ≥ 40 Gy: RR, 19.48 [95% CI, 8.73 to 43.48]), having received busulfan (RR, 4.53 [95% CI, 2.10 to 9.77]), or > 300 mg/m2 of lomustine (300-600 mg/m2: RR, 4.21 [95% CI, 1.61 to 11.01] and ≥ 600 mg/m2: RR, 9.12 [95% CI, 2.75 to 30.24]) were all independent risk factors for SAH. Irradiation of ≥ 7 vertebrae (≥ 15 Gy on ≥ 90% of their volume) without pituitary irradiation increased the RR of SAH by 4.62 (95% CI, 2.77 to 7.72). If patients had also received pituitary irradiation, this increased the RR by an additional factor of 1.3 to 2.4. CONCLUSION CCS are at a high risk of SAH. CCS treated with radiotherapy, busulfan, or lomustine should be closely monitored for growth, puberty onset, and potential pituitary deficiency.

Growth hormone deficiency and cardiovascular risk factors in childhood cancer survivors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6614-6614
Author(s):  
K. Gujral ◽  
A. Petryk ◽  
L. Steffen ◽  
K. Baker ◽  
J. Perkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Visceral Fat ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Percent Body Fat ◽  
Cvd Risk Factors ◽  
Cvd Risk

6614 Background: Childhood cancer survivors (CCS) have a high frequency of growth hormone deficiency (GHD) and risk of early cardiovascular disease (CVD). This study examined the relations between GHD and risk factors for CVD in CCS. Methods: Anthropometrics, blood pressure, lipids, growth hormone (GH) stimulation test, dual-energy x-ray absorptiometry, abdominal CT, and insulin resistance (IR) (euglycemic, hyperinsulinemic clamp - low M/lbm signifies IR) were obtained in 174 CCS, mean age 15±2 years and 89 healthy sibling controls, mean age 13.5±3 years. Linear regression evaluated the relations between GHD and CVD risk factors, adjusted for sex, age, pubertal stage, and body mass index (BMI) or visceral fat. Results: 62 CCS (36%) had GHD. There were no significant measurement differences between non-GHD CCS and controls. Compared to controls, GHD CCS who never received GH (N = 34) had greater BMI (24.8 vs 20.8 kg/m2, p < 0.0001), percent body fat (36.1% vs 25.8%, p < 0.0001), visceral fat (34.8 vs 19.6 cm2, p < 0.0001), and triglycerides (TG) (120.2 vs 83.8 mg/dL, p = 0.001) and were more IR (M/lbm 11.1 vs 14.2 mg/kg/min, p = 0.0006). Adjustment for BMI and visceral fat did not change the IR or TG results. GHD CCS currently on GH had lower BMI (21.9 kg/m2, p = 0.02), percent body fat (31.2%, p = 0.08), and visceral fat (26.5 cm2, p = 0.03) compared to those not treated. IR and TG were not different between treated and not treated GHD CCS. Conclusions: GHD is a common finding in CCS and is significantly associated with adiposity, IR, and elevated TG.There is a suggestion that GH treatment had a positive impact on adiposity, but not IR and TG levels. These study findings imply that CVD risk factors are present in CCS with GHD independent of body fatness, suggesting that the cancer diagnosis or treatments received may lead to early cardiovascular disease in childhood cancer survivors. No significant financial relationships to disclose.

scholarly journals Childhood Cancer and the Risk of ESKD

2020 ◽  
pp. ASN.2020071002
Author(s):  
Ronit Calderon-Margalit ◽  
Oren Pleniceanu ◽  
Dorit Tzur ◽  
Michal Stern-Zimmer ◽  
Arnon Afek ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Military Service ◽  
Benign Tumor ◽  
Childhood Cancer Survivors ◽  
Cox Proportional Hazards ◽  
Benign Tumors ◽  
Increased Risk ◽  
History Of

BackgroundIncreasing cancer incidence among children alongside improved treatments has resulted in a growing number of pediatric cancer survivors. Despite childhood cancer survivors’ exposure to various factors that compromise kidney function, few studies have investigated the association between childhood cancer and future kidney disease.MethodsTo assess the risk of ESKD among childhood cancer survivors, we conducted a nationwide, population-based, retrospective cohort study that encompassed all Israeli adolescents evaluated for mandatory military service from 1967 to 1997. After obtaining detailed histories, we divided the cohort into three groups: participants without a history of tumors, those with a history of a benign tumor (nonmalignant tumor with functional impairment), and those with a history of malignancy (excluding kidney cancer). This database was linked to the Israeli ESKD registry to identify incident ESKD cases. We used Cox proportional hazards models to estimate the hazard ratio (HR) of ESKD.ResultsOf the 1,468,600 participants in the cohort, 1,444,345 had no history of tumors, 23,282 had a history of a benign tumor, and 973 had a history of malignancy. During a mean follow-up of 30.3 years, 2416 (0.2%) participants without a history of tumors developed ESKD. Although a history of benign tumors was not associated with an increased ESKD risk, participants with a history of malignancy exhibited a substantially elevated risk for ESKD compared with participants lacking a history of tumors, after controlling for age, sex, enrollment period, and paternal origin (adjusted HR, 3.2; 95% confidence interval, 1.3 to 7.7).ConclusionsChildhood cancer is associated with an increased risk for ESKD, suggesting the need for tighter and longer nephrological follow-up.

Prevalence and risk factors of radiation-induced growth hormone deficiency in childhood cancer survivors: A systematic review

2009 ◽  
Vol 35 (7) ◽  
pp. 616-632 ◽  
Author(s):  
Renée L. Mulder ◽  
Leontien C.M. Kremer ◽  
Hanneke M. van Santen ◽  
Jan Lucas Ket ◽  
A.S. Paul van Trotsenburg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Growth Hormone ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Growth Hormone Deficiency ◽  
Childhood Cancer Survivors ◽  
Hormone Deficiency ◽  
Radiation Induced
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