ESPE Abstracts

Background: Primary brain tumors are the most prevalent solid tumors among children. Both the tumor itself and therapeutic interventions can lead to endocrine complications and metabolic consequences in survivors. However, current information on these complications in childhood brain tumor survivors (CBTS) in Thailand is limited.

Objectives: This study aims to evaluate the prevalence of endocrine and metabolic complications in CBTS and to identify risk factors associated with unfavorable endocrine outcomes.

Methods: A cross-sectional study was conducted on patients diagnosed with primary brain tumors before 15 years old, and completed treatment for at least one year with no residual tumor or stable disease at Chiang Mai University Hospital. Patients with pre-existing endocrine diseases before the diagnosis of primary brain tumor or with chromosomal abnormalities were excluded. The prevalence of endocrine and metabolic disorders was calculated. Multivariable logistic regression was used to analyze associations between clinical variables and endocrine complications.

Results: Fifty-eight CBTS (28F/30M) with a median age at the diagnosis of brain tumor of 8.1 years were included. Medulloblastoma (32.8%) was the most prevalent neoplasm, followed by germ cell tumor (24.1%). The majority of CBTS had been treated with a combination of surgery, chemotherapy and/or radiotherapy. A total of 36 patients (62.1%) developed at least one endocrine disorder (44.4% at initial presentation and 55.6% after brain tumor diagnosis). The most frequent endocrine complications overall were TSH deficiency, growth hormone (GH) deficiency, and ACTH deficiency (41.4%, 34.6%, and 32.8%, respectively). At initial presentation, TSH deficiency (20.7%) and central diabetes insipidus (CDI) (17.2%) were the most prevalent. After tumor diagnosis, GH deficiency wasthe most common endocrine complication. The median time to develop any endocrine disorders was 5 years (range: 2.9-6.2 years). The highest prevalence of endocrinopathies was observed in children with sellar/suprasellar tumors (38.9%); followed by posterior fossa tumors (36.1%), supratentorial tumors (16.7%), and pineal tumors (8.3%). Patients with sellar/suprasellar tumors had a significantly higher risk of developing GH deficiency (odds ratio (OR), 22.57; P =0.003), hypogonadotropic hypogonadism (OR, 125.21; P <0.001) and CDI (OR, 863.97; P <0.001). Additionally, patients who had metastasis were more likely to develop GH deficiency compared to those who did not (OR, 13.28; P =0.005). Furthermore, CBTS experienced a high prevalence of dyslipidemia (64.3%) and dysglycemia (prediabetes 10.3 % and diabetes 3.4%)

Conclusion: Endocrinopathies and metabolic complications are prevalent among CBTS and often manifest either at initial presentation or within the first five years post-diagnosis. Therefore, regular monitoring for endocrine and metabolic complications and timely interventions are necessary for these patients.