ESPE Abstracts

Growth failure is common in radiotherapy-treated long-term survivors of pediatric brain tumors. The aim of this study was to assess the changes in growth patterns before and after brain tumor diagnosis, the final height, and the risk factors for compromised growth. The incidence and treatment practices of growth hormone deficiency were analyzed.

Methods: A cohort of 73 long-term survivors of childhood brain tumor (median age 27.2 years) were studied after a median follow-up period of 20.4 years from diagnosis (IQR 14.9 to 22.9 years). Patients were treated in five university hospitals in Finland between 1970 and 2008. Growth curves, final height, and patient- and disease-related risk factors for compromised growth during different growth periods were analyzed. Laboratory analyses for growth hormone status were performed at the follow-up.

Results: Low IGF-1 level was found in 32% (24/73), and untreated growth hormone deficiency in 41% (30/73) of the patients at the follow-up. Growth failure was already evident at diagnosis, with a mean height decline of -0.6 SDS (standard deviation score) from birth (95% CI -1.15 to -0.05). Loss of growth potential continued after diagnosis, with a mean height SDS decline of -1.09 SDS (95%CI -1.51 to -0.66). At follow-up, 37% of the patients (27/73) had true adult short stature (height < -2 SDS). The mean height deficit when corrected for target height was -1.9 SDS (95% CI -1.45 to -2.40). Growth failure was associated with young age at diagnosis.

Conclusion: Adult short stature was common in radiotherapy-treated survivors of childhood brain tumor. The growth decline was already evident at diagnosis. Growth failure associated with young age at diagnosis. These patients had a high prevalence of low IGF-1 level suggesting untreated growth hormone deficiency in adulthood.