Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours

Presentation and long-term outcomes

Wassim Chemaitilly, Thomas E. Merchant, Zhenghong Li, Nicole Barnes, Gregory Armstrong, Kirsten K. Ness, Ching Hon Pui, Larry E. Kun, Leslie L. Robison, Melissa M. Hudson, Charles A. Sklar, Amar Gajjar

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives To estimate the prevalence of central precocious puberty (CPP) after treatment for tumours and malignancies involving the central nervous system (CNS) and examine repercussions on growth and pubertal outcomes. Design Retrospective study of patients with tumours near and/or exposed to radiotherapy to the hypothalamus/pituitary axis (HPA). Patients and Measurements Patients with CPP were evaluated at puberty onset, completion of GnRH agonist treatment (GnRHa) and last follow-up. Multivariable analysis was used to test associations between tumour location, sex, age at CPP, GnRHa duration and a diagnosis of CPP with final height <-2SD score (SDS), gonadotropin deficiency (LH/FSHD) and obesity, respectively. Results Eighty patients (47 females) had CPP and were followed for 11·4 ± 5·0 years (mean ± SD). The prevalence of CPP was 15·2% overall, 29·2% following HPA tumours and 6·6% after radiotherapy for non-HPA tumours. Height <-2SDS was more common at the last follow-up than at the puberty onset (21·4% vs 2·4%, P = 0·005). Obesity was more prevalent at the last follow-up than at the completion of GnRHa or the puberty onset (37·7%, 22·6% and 20·8%, respectively, P = 0·03). Longer duration of GnRHa was associated with increased odds of final height <-2SDS (OR = 2·1, 95% CI 1·0-4·3) and longer follow-up with obesity (OR = 1·3, 95% CI 1·1-1·6). LH/FSHD was diagnosed in 32·6%. There was no independent association between CPP and final height <-2SDS, and LH/FSHD and obesity in the subset of patients with HPA low-grade gliomas. Conclusions Patients with organic CPP experience an incomplete recovery of growth and a high prevalence of LH/FSHD and obesity. Early diagnosis and treatment of CPP may limit further deterioration of final height prospects.

Original languageEnglish (US)
Pages (from-to)361-371
Number of pages11
JournalClinical Endocrinology
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2016

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Central Nervous System Neoplasms
Pediatrics
Gonadotropin-Releasing Hormone
Obesity
Neoplasms
Puberty
Hypothalamus
Therapeutics
Pituitary Neoplasms
Radiotherapy
Central Precocious Puberty
Growth
Gonadotropins
Glioma
Early Diagnosis
Central Nervous System
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours : Presentation and long-term outcomes. / Chemaitilly, Wassim; Merchant, Thomas E.; Li, Zhenghong; Barnes, Nicole; Armstrong, Gregory; Ness, Kirsten K.; Pui, Ching Hon; Kun, Larry E.; Robison, Leslie L.; Hudson, Melissa M.; Sklar, Charles A.; Gajjar, Amar.

In: Clinical Endocrinology, Vol. 84, No. 3, 01.03.2016, p. 361-371.

Research output: Contribution to journalArticle

Chemaitilly, W, Merchant, TE, Li, Z, Barnes, N, Armstrong, G, Ness, KK, Pui, CH, Kun, LE, Robison, LL, Hudson, MM, Sklar, CA & Gajjar, A 2016, 'Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours: Presentation and long-term outcomes', Clinical Endocrinology, vol. 84, no. 3, pp. 361-371. https://doi.org/10.1111/cen.12964
Chemaitilly, Wassim ; Merchant, Thomas E. ; Li, Zhenghong ; Barnes, Nicole ; Armstrong, Gregory ; Ness, Kirsten K. ; Pui, Ching Hon ; Kun, Larry E. ; Robison, Leslie L. ; Hudson, Melissa M. ; Sklar, Charles A. ; Gajjar, Amar. / Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours : Presentation and long-term outcomes. In: Clinical Endocrinology. 2016 ; Vol. 84, No. 3. pp. 361-371.
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abstract = "Objectives To estimate the prevalence of central precocious puberty (CPP) after treatment for tumours and malignancies involving the central nervous system (CNS) and examine repercussions on growth and pubertal outcomes. Design Retrospective study of patients with tumours near and/or exposed to radiotherapy to the hypothalamus/pituitary axis (HPA). Patients and Measurements Patients with CPP were evaluated at puberty onset, completion of GnRH agonist treatment (GnRHa) and last follow-up. Multivariable analysis was used to test associations between tumour location, sex, age at CPP, GnRHa duration and a diagnosis of CPP with final height <-2SD score (SDS), gonadotropin deficiency (LH/FSHD) and obesity, respectively. Results Eighty patients (47 females) had CPP and were followed for 11·4 ± 5·0 years (mean ± SD). The prevalence of CPP was 15·2{\%} overall, 29·2{\%} following HPA tumours and 6·6{\%} after radiotherapy for non-HPA tumours. Height <-2SDS was more common at the last follow-up than at the puberty onset (21·4{\%} vs 2·4{\%}, P = 0·005). Obesity was more prevalent at the last follow-up than at the completion of GnRHa or the puberty onset (37·7{\%}, 22·6{\%} and 20·8{\%}, respectively, P = 0·03). Longer duration of GnRHa was associated with increased odds of final height <-2SDS (OR = 2·1, 95{\%} CI 1·0-4·3) and longer follow-up with obesity (OR = 1·3, 95{\%} CI 1·1-1·6). LH/FSHD was diagnosed in 32·6{\%}. There was no independent association between CPP and final height <-2SDS, and LH/FSHD and obesity in the subset of patients with HPA low-grade gliomas. Conclusions Patients with organic CPP experience an incomplete recovery of growth and a high prevalence of LH/FSHD and obesity. Early diagnosis and treatment of CPP may limit further deterioration of final height prospects.",
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AU - Chemaitilly, Wassim

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AU - Li, Zhenghong

AU - Barnes, Nicole

AU - Armstrong, Gregory

AU - Ness, Kirsten K.

AU - Pui, Ching Hon

AU - Kun, Larry E.

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

AU - Sklar, Charles A.

AU - Gajjar, Amar

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N2 - Objectives To estimate the prevalence of central precocious puberty (CPP) after treatment for tumours and malignancies involving the central nervous system (CNS) and examine repercussions on growth and pubertal outcomes. Design Retrospective study of patients with tumours near and/or exposed to radiotherapy to the hypothalamus/pituitary axis (HPA). Patients and Measurements Patients with CPP were evaluated at puberty onset, completion of GnRH agonist treatment (GnRHa) and last follow-up. Multivariable analysis was used to test associations between tumour location, sex, age at CPP, GnRHa duration and a diagnosis of CPP with final height <-2SD score (SDS), gonadotropin deficiency (LH/FSHD) and obesity, respectively. Results Eighty patients (47 females) had CPP and were followed for 11·4 ± 5·0 years (mean ± SD). The prevalence of CPP was 15·2% overall, 29·2% following HPA tumours and 6·6% after radiotherapy for non-HPA tumours. Height <-2SDS was more common at the last follow-up than at the puberty onset (21·4% vs 2·4%, P = 0·005). Obesity was more prevalent at the last follow-up than at the completion of GnRHa or the puberty onset (37·7%, 22·6% and 20·8%, respectively, P = 0·03). Longer duration of GnRHa was associated with increased odds of final height <-2SDS (OR = 2·1, 95% CI 1·0-4·3) and longer follow-up with obesity (OR = 1·3, 95% CI 1·1-1·6). LH/FSHD was diagnosed in 32·6%. There was no independent association between CPP and final height <-2SDS, and LH/FSHD and obesity in the subset of patients with HPA low-grade gliomas. Conclusions Patients with organic CPP experience an incomplete recovery of growth and a high prevalence of LH/FSHD and obesity. Early diagnosis and treatment of CPP may limit further deterioration of final height prospects.

AB - Objectives To estimate the prevalence of central precocious puberty (CPP) after treatment for tumours and malignancies involving the central nervous system (CNS) and examine repercussions on growth and pubertal outcomes. Design Retrospective study of patients with tumours near and/or exposed to radiotherapy to the hypothalamus/pituitary axis (HPA). Patients and Measurements Patients with CPP were evaluated at puberty onset, completion of GnRH agonist treatment (GnRHa) and last follow-up. Multivariable analysis was used to test associations between tumour location, sex, age at CPP, GnRHa duration and a diagnosis of CPP with final height <-2SD score (SDS), gonadotropin deficiency (LH/FSHD) and obesity, respectively. Results Eighty patients (47 females) had CPP and were followed for 11·4 ± 5·0 years (mean ± SD). The prevalence of CPP was 15·2% overall, 29·2% following HPA tumours and 6·6% after radiotherapy for non-HPA tumours. Height <-2SDS was more common at the last follow-up than at the puberty onset (21·4% vs 2·4%, P = 0·005). Obesity was more prevalent at the last follow-up than at the completion of GnRHa or the puberty onset (37·7%, 22·6% and 20·8%, respectively, P = 0·03). Longer duration of GnRHa was associated with increased odds of final height <-2SDS (OR = 2·1, 95% CI 1·0-4·3) and longer follow-up with obesity (OR = 1·3, 95% CI 1·1-1·6). LH/FSHD was diagnosed in 32·6%. There was no independent association between CPP and final height <-2SDS, and LH/FSHD and obesity in the subset of patients with HPA low-grade gliomas. Conclusions Patients with organic CPP experience an incomplete recovery of growth and a high prevalence of LH/FSHD and obesity. Early diagnosis and treatment of CPP may limit further deterioration of final height prospects.

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