Abstract: The development of endocrine disorders after complex treatment of medulloblastoma is out of doubt. Much less attention is paid to the study of metabolic changes in the outcome of treatment. In our clinic, we examined 63 patients (40 males/23 females) after the complex therapy of medulloblastoma (surgery, craniospinal radiation therapy and chemotherapy). Patients had a median age (range) of 11.3 (5.5÷17.9) years. They were treated for medulloblastoma when aged 6.8 (1.2÷16.2) years. The median time after the end of treatment was 3.7 (1,5÷11,6) years. Overweight (SDS BMI >1) was observed only in 16 patients (3 girls and 13 boys), obesity (SDS BMI >2) in 1 boy. Dyslipidemia was found in 34 patients (54%). All patients underwent oral glucose tolerance test. Insulin resistance (ISI Matsuda <2,5, HOMA-IR >3.2) was detected in 7 patients, impaired glucose tolerance (120 min glucose ≥7.8 mmol/l) was observed in 2 patients with IR and in 2 patients without IR. At the same time, IR and impaired glucose tolerance were encountered in only 5 children with overweight and no one with obesity. All patients with impaired glucose tolerance had normal values of fasting glucose (4.3 ÷ 5.04 mmol/l) and HbA1c (4.8 ÷ 5.8%). A bioelectrical impedanciometer was used to measure body composition in 49 cases, the percentage of adipose tissue was increased in 14 patients (28%) with normal BMI (<1). Resting metabolic rate (RMR) was calculated using indirect calorimetry, with a gas exchange analyzer to measure oxygen use and carbon dioxide production. In 25 patients there was normal RMR, in 16 there was low RMR, and 7 patients had high RMR. We compared the basal metabolic rate before the start of growth hormone therapy and 6-12 months after In 6 patients, no significant changes were detected.
In our group of patients after complex therapy for medulloblastoma metabolic changes, such as dyslipidemia were observed in 54 percent of children (34/63). Insulin resistance and impaired glucose tolerance, were found in 14 percent of children (9/63), while 74 percent of patients had a normal or low body mass index. In this group of patients, it is necessary to conduct careful follow up including oral glucose tolerance test and measure of body composition.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology