Hypothalamic-Pituitary Dysfunction in Survivors of Childhood Brain Tumors in Prasat Neurological Institute
Apasri Lusawat MD*, Kanlaya Dhiravibulya MD*, Sasipa Thammongkol MD*, Somlak Vanavanan MSc**, Pat Mahachoklertwattana MD***
Affiliation : * Department of Pediatric Neurology, Prasat Neurological Institute, Bangkok, Thailand ** Biochemical laboratory of Department of Pathology, Ramathibodi Hospital, Bangkok, Thailand *** Pediatric endocrinology unit of Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand
Objective : To assess hypothalamic-pituitary dysfunction in childhood brain tumor survivors in Prasat
Neurological Institute.
Material and Method: Between October 2007 and September 2008, 19 brain tumor survivor children in
Prasat Neurological Institute without recurrence at least 2 years after complete treatment were included
in the present study. The patients were categorized according to brain tumor location into directly (DHPA)
(9 cases) and indirectly (IDHPA) (10 cases) involving hypothalamic-pituitary axis. All patients were treated
by surgery. Furthermore, six cases were combined with radiation and chemotherapy and 10 cases were
combined with radiation therapy only. Growth Hormone (GH) stimulation test by clonidine and/or L-Dopa,
ACTH stimulation test and thyroid function test (TFT) were done.
Results : The mean age at diagnosis was 9.9 + 4.6 years old and the interval from diagnosis to study was 5.8 +
2.2 years. Seven DHPA (77%) and seven IDHPA patients (70%) had low peak GH with significant lower level
in the former group (p < 0.05). Six of seven DHPA (85%) and one IDHPA patients (10%) had low response to
ACTH stimulation test. All DHPA (100%) and 10% IDHPA patients had central hypothyroidism. By ACTH
stimulation test in DHPA patients, hypocortisolism was detected in five and excluded in one who later stopped
prednisolone after prolonged continuation. The central hypothyroidism was newly detected in two DHPA
patients and replacement therapy was initiated. GH deficiency (GHD) was detected by GH stimulation test in
73% of overall brain tumors. Growth hormone therapy would be considered in the appropriate GHD patients.
Conclusion : With effective therapy and improving survival rates of brain tumor children, hypothalamic-
pituitary dysfunction in either DHPA or IDHPA group should be regularly monitored to prevent further
morbidity and improve quality of life.
Keywords : Brain tumor, Children, Hypothalamic-pituitary dysfunction
