Clinical experience of growth hormone replacement for pediatric intracranial germ cell tumor
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ORIGINAL ARTICLE
Clinical experience of growth hormone replacement for pediatric intracranial germ cell tumor Kentaro Chiba 1 & Yasuo Aihara 1
&
Takakazu Kawamata 1
Received: 8 October 2019 / Accepted: 14 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Intracranial germ cell tumors (IGCTs) account for 8–15% of brain tumors in children in Eastern Asia and typically occur at the age of puberty. Recently, adjuvant therapy has been modified to ameliorate post-treatment complications such as cognitive dysfunction, in patients with IGCT. However, endocrine problems remain to be resolved. There is reluctance to use growth hormone (GH) at an early stage after treatment for IGCT because of the risk of tumor recurrence; however, GH replacement must be administered before the onset of puberty in children with short stature. There is little guidance on this issue due to a lack of literature on the risks of GH replacement therapy in patients with IGCT. This study aimed to evaluate the safety of GH replacement. Methods In this retrospective study, 6 patients with IGCT who were under the age of 18 years when they started GH replacement therapy were reviewed. Histopathological analysis and/or analysis of tumor markers was used to confirm a diagnosis. Results All six cases who underwent GH replacement therapy showed no recurrence. GH replacement therapy was administered in 5 patients for short stature and all achieved a height within ± 2.0 standard deviation. Conclusion GH replacement for children with IGCT was safe in our case series. Placental alkaline phosphatase levels in cerebrospinal fluid can be used to facilitate the decision on when to initiate GH replacement. Keywords Children . Germ cell tumors . Growth hormone . Short stature
Introduction Intracranial germ cell tumors (IGCTs) account for 8–15% of pediatric brain tumors in Eastern Asia, with 2.7/million/year in Japan [1–3]. IGCT consists of a heterogenous group of tumors that includes germinoma, mature/immature teratoma, yolk sack tumor, and choriocarcinoma [2, 4]. Of these, germinoma responds particularly well to adjuvant therapy, and the 10-year and 20-year overall survival rates have been reported to be 92.7% and 80.6%, respectively, i.e., germinoma is potentially curable without recurrence [3–5]. While modified adjuvant therapies for germinoma can increase the number of long-term survivors, endocrine deficiencies as a result of tumor, surgery, or adjuvant therapy remain to be resolved [6]. Almost 70% of all pre-pubescent and adolescent patients
* Yasuo Aihara [email protected] 1
Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo 162-8666, Japan
with IGCT aged 10–24 years with polyphyletic endocrine disorders require long-term treatment with one or more hormones, of these, growth hormone (GH) secretion is commonly affected by hypothalamus impairment [2, 3, 7–9]. A number of physical and mental disorders, including short stature, obesity, hyperglycemia, anxiety, depressio
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