Endocrine Abstracts

Introduction: Improved survival following treatment for paediatric medulloblastomas has resulted in increased incidence of late effects, particularly endocrine sequelae. The complete picture of late effects, however, has been limited by short duration of follow up.

Aims 1: To establish the evolution of endocrine sequelae in patients treated for medulloblastoma

Aim 2: To compare the prevalence of endocrine dysfunction among three major treatment regimens.

Methods: Single-centre analysis of medulloblastoma treatment and endocrine sequelae in patients diagnosed between 1982 and 2002.

Results: A total of 109 patients were treated for medulloblastoma. Only 45 (41%) patients remained alive, and details of treatment and late effects were available for 35 of them (25 M). The median age at diagnosis was eight (range 2–14) years and median follow up was 18 (range 10–28) years. Growth hormone deficiency (GHD) was the most prevalent hormone deficiency (97%), followed by hypothyroidism (60%) and adrenocorticotrophic hormone (ACTH) deficiency (45.5%). The median time from end of treatment to loss of growth hormone was 1.7 (range 0.7–15) years; ACTH deficiency 2.9 (range 0.75–7.5) years; and hypothyroidism 4.1 (range 0.7–11.4) years. Twenty three per cent developed hypogonadism (17% primary and 6% secondary) whilst precocious puberty was seen in 20%. The total number of endocrine events was highest for patients receiving Packer regimen (cysplatin, Vincristine and CCNU with radiotherapy) (n=10) at 2.8 events/patient, followed by 2.4 events/patient for those receiving PNET3 with chemotherapy (n=10) and least in patients receiving PNET3 without chemo (n=8) at two events/patient. We also present the cause of death and prevalence of endocrine dysfunction among non-survivors.

Conclusions: Prevalence of endocrine sequelae in medulloblastoma survivors is high and evolution of endocrine dysfunction can occur as late as 15 years from treatment completion, hence long term close monitoring of growth, puberty and gonadal function is essential. Endocrinopathies appear to be more prevalent in those treated with concomitant chemotherapy and radiotherapy.