Brain tumours are the most common solid tumour in children, affecting 400 children in the UK each year. The aggressive treatment required for cure, may have serious consequences, of which endocrine late effects are the most prevalent.
This aim of this audit is to ascertain the frequency and nature of endocrine late effects; in a cohort of 30 survivors, diagnosed over a fourteen year period. Data was collected on tumour site, histology, treatments used & endocrine complications.
70% of children underwent surgery, 87% received chemotherapy, 40% received cranial radiotherapy, 23% received craniospinal radiotherapy and 16% children received both cranial and craniospinal radiotherapy.
36% of survivors were diagnosed with growth hormone deficiency (all of these children had received radiotherapy). Impaired spinal growth was seen in all children who had received craniospinal radiotherapy, exacerbating short stature. 23% of children were found to have a suboptimal cortisol response; necessitating emergency hydrocortisone treatment. 20% of survivors developed hypothyroidism. Onset of hypothyroidism ranged from 1 to 5 years following treatment. 11% of survivors were diagnosed with precocious puberty; which in 1 case had masked a growth hormone deficiency.
In conclusion, this audit confirms the high prevalence of endocrine late effects in survivors of childhood brain tumours. Growth hormone deficiency was the most common, however there was a high percentage of multiple hormone deficiencies. Data support the establishment of a joint oncology and endocrinology late effects clinic; to ensure early identification and treatment of these serious complications.