Abstract
The growth response to growth hormone (GH) therapy has been studied in 12 children who received irradiation to the cranium alone either for brain gliomas, distant from the hypothalamic-pituitary axis, or as prophylaxis against CNS leukaemia. Seven children have completed GH treatment (mean duration 4 years) and five are presently on GH (mean duration 1.2 years). This response has been compared to that seen in 14 children with isolated idiopathic GH deficiency (IGHD), following GH therapy. Before treatment, the cranially irradiated patients (C-PRGHD) had higher standard deviation scores (SDS) for standing height, sitting height and leg length, and less bone age (BA) retardation, but started treatment at a similar age, and with a similar pre-treatment growth velocity and GH peak to standard provocative tests, compared to IGHD patients. GH produced a significant and similar increase in growth velocity (cm/year and SDS for BA) over the first 2 years' treatment in both groups. However C-PRGHD patients entered puberty and thus completed growth earlier than the IGHD group. As a result, cranially-irradiated children showed no change in height SDS with GH therapy, compared to catch-up growth in IGHD. Nevertheless, GH has enabled C-PRGHD patients to maintain their centile position and to achieve a more acceptable final height.
Similar content being viewed by others
Abbreviations
- GH:
-
growth hormone
- IGHD:
-
idiopathic growth hormone deficiency
- C-PRGHD:
-
post cranial-irradiation growth hormone deficiency
- SDS:
-
standard deviation score
- BA:
-
bone age
- ALL:
-
acute lymphatic leukaemia
- TSH:
-
thyroid stimulating hormone
- CA:
-
chronological age
- HA:
-
height age
References
Ahmed SR, Shalet SM (1984) Hypothalamic growth hormone releasing factor deficiency following cranial irradiation. Clin Endocrinol 21:483–488
Bamford FN, Morris Jones PH, Pearson D, Ribeiro GG, Shalet SM, Beardwell CG (1976) Residual disabilities in children treated for intracranial space-occupying lesions. Cancer 37:1149–1151
Brauner R, Czernichow P, Rappaport R (1984) Precocious puberty after hypothalamic and pituitary irradiation in young children. N Engl J Med 311:920
Brauner R, Czernichow P, Prevot C, Guyda H, Rappaport R (1985) Longitudinal study of growth hormone secretion, somatomedin and growth in the two years following cranial irradiation. Pediatr Res 19:613 (abstr)
Clayton PE, Price DA, Shalet SM (1987) Growth hormone state after completion of growth hormone treatment in childhood. Arch Dis Child 62:222–226
Dickinson WP, Berry BH, Dickinson L, Irvin M, Schedewie H, Fiser RH, Elders MJ (1978) Differential effects of cranial irradiation on growth hormone response to arginine and insulin infusion. J Pediatr 92:754–757
Herber SM, Milner RDG (1986) When are we diagnosing growth hormone deficiency? Arch Dis Child 61:110–112
Lustig RH, Schriock EA, Kaplan SL, Grumbach MM (1985) Effects of hypothalamic GH-releasing factor on GH release in children with radiation-induced GH deficiency. Pediatrics 76:274–279
Marshall WA, Tanner JM (1969) Variations in the pattern of pubertal changes in girls. Arch Dis Child 44:291–303
Marshall WA, Tanner JM (1970) Variation in the pattern of pubertal development in boys. Ibid 45:13–23
Mosier HD, Janson RA (1967) Stunted growth in rats following X-irradiation of the head. Growth 31:139–148
Onoyama Y, Abe M, Takahashi M, Yabumoto E, Sakamoto T (1975) Radiation therapy of brain tumours in children. Radiology 115:687–693
Romshe CA, Zipf WB, Miser A, Miser J, Sotos JF, Newton WA (1984) Evaluation of growth hormone release and human growth hormone treatment in children with cranial irradiation-associated short stature. J Pediatr 104:177–181
Rona RJ, Tanner JM (1978) Aetiology of idiopathic growth hormone deficiency in England and Wales. Arch Dis Child 52:197–208
Samaan NA, Vieto R, Schultz PN, Maor M, Meoz RT, Sampiere VA, Cangir A, Ried HL, Jesse RH (1982) Hypothalamic, pituitary and thyroid dysfunction after radiotherapy to the head and neck. Int J Radiat Oncol Biol Phys 8:1857–1867
Seckel HPG (1960) Concepts relating the pituitary growth hormone to somatic growth of the normal child. Am J Dis Child 99: 349–379
Shalet SM, Beardwell CG, Morris Jones PH, Pearson D (1975) Pituitary function after treatment of intracranial tumours in children. Lancet II:104–107
Shalet SM, Beardwell CG, Pearson D, Morris Jones PH (1976) The effect of varying doses of cerebral irradiation on GH production in childhood. Clin Endocrinol 5:287–290
Shalet SM, Beardwell CG, MacFarlane IA, Morris Jones PH, Pearson D (1977) Endocrine morbidity in adults treated with cerebral irradiation for brain tumours during childhood. Acta Endocrinol 84:673–680
Shalet SM, Beardwell CG, Aarons BM, Pearson D, Morris Jones PH (1978) Growth impairment of children treated for brain tumours. Arch Dis Child 53:491–494
Shalet SM, Price DA, Beardwell CG, Morris Jones PH, Pearson D (1979) Normal growth despite abnormalities of growth hormone secretion in children treated for acute leukaemia. J Pediatr 94:719–722
Shalet SM, Whitehead E, Chapman AJ, Beardwell CG (1981) The effects of GH therapy in chidren with radiation-induced growth hormone deficiency. Acta Paediatr Scand 70:81–86
Starceski PJ, Lee PA, Blatt J, Finegold D, Brown D (1987) Comparable effects of 1800- and 2400-rad (18- and 24-Gy) cranial irradiation on height and weight in children treated for acute lymphocytic leukaemia. Am J Dis Child 141:550–552
Tanner JM (1978) Physical growth and development. In: Forfar JO, Arneil GC (eds) Textbook of Paediatrics. Churchill Livingstone, Edinburgh
Tanner JM, Whitehouse RH, Cameron N, Marshall WA, Healey MJR, Goldstein H (1983) Assessment of skeletal maturity and prediction of adult height (TW2 method). Academic Press, London
Wells RJ, Foster MB, D'Ercole J, McMillan CW (1983) The impact of cranial irradiation on the growth of children with acute lymphocytic leukaemia. Am J Dis Child 137:37–39
Winter RJ, Green OC (1985) Irradiation-induced growth hormone deficiency: blunted growth response and accelerated skeletal maturation to growth hormone therapy. J Pediatr 106:609–612
Yamazaki JN, Bennett CR, McFall RA, Clemente CD (1960) Brain radiation in newborn rats and differential effects of increased age. I. Clinical observations. Neurology 10:530–536
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Clayton, P.E., Shalet, S.M. & Price, D.A. Growth response to growth hormone therapy following cranial irradiation. Eur J Pediatr 147, 593–596 (1988). https://doi.org/10.1007/BF00442470
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00442470