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Prevalence and risk factors of hypothalamic–pituitary dysfunction in infant and toddler childhood brain tumor survivors

Authors: C A Lebbink; T P Ringers; A Y N Schouten-van Meeteren; L van Iersel; S C Clement; A M Boot; H L Claahsen-van der Grinten; +8 Authors

Prevalence and risk factors of hypothalamic–pituitary dysfunction in infant and toddler childhood brain tumor survivors

Abstract

Objective Childhood brain tumor survivors (CBTS) are at risk to develop hypothalamic–pituitary (HP) dysfunction (HPD). The risk for HPD may vary between different age groups due to maturation of the brain and differences in oncologic treatment protocols. Specific studies on HPD in infant brain tumor survivors (infant-BTS, 0–1 years at diagnosis) or toddler brain tumor survivors (toddler-BTS, ≥1–3 years) have not been performed. Patients and methods A retrospective nationwide cohort study in CBTS was performed. Prevalence and risk factors for HPD were compared between infant-, toddler-, and older-BTS. Subgroup analysis was performed for all non-irradiated CBTS (n = 460). Results In total, 718 CBTS were included, with a median follow-up time of 7.9 years. Overall, despite the less frequent use of radiotherapy (RT) in infants, no differences in the prevalence of HPD were found between the three groups. RT (OR: 16.44; 95% CI: 8.93–30.27), suprasellar tumor location (OR: 44.76; 95% CI: 19.00–105.49), and younger age (OR: 1.11; 95% CI: 1.05–1.18) were associated with HP dysfunction. Infant-BTS and toddler-BTS showed more weight gain (P < 0.0001) and smaller height SDS (P = 0.001) during follow-up. In non-irradiated CBTS, infant-BTS and toddler-BTS were significantly more frequently diagnosed with TSH-, ACTH-, and ADH deficiency, compared to older-BTS. Conclusion Infant and toddler brain tumor survivors seem to be more vulnerable to develop HP dysfunction than older children. These results emphasize the importance of special infant and toddler brain tumor treatment protocols and the need for endocrine surveillance in children treated for a brain tumor at a young age.

Keywords

Adult, Male, Adolescent, Pituitary Diseases, Netherlands/epidemiology, Pituitary Diseases/epidemiology, Cohort Studies, Young Adult, Cancer Survivors, Risk Factors, Hypothalamic Diseases/epidemiology, Journal Article, Prevalence, Humans, Paediatrics - Radboud University Medical Center, Age of Onset, Child, Netherlands, Retrospective Studies, Radboudumc 16: Vascular damage RIMLS: Radboud Institute for Molecular Life Sciences, Brain Neoplasms, Infant, Brain Neoplasms/complications, Child, Preschool, Female, Hypothalamic Diseases, Cancer Survivors/statistics & numerical data, Follow-Up Studies

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    popularity
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    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Average
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
4
Top 10%
Average
Average
Green
hybrid