University of Oulu

Anttonen J, Remes T, Arikoski P, Lähteenmäki P, Arola M, Harila-Saari A, et al. (2022) Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor. PLoS ONE 17(9): e0274274.

Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor

Saved in:
Author: Anttonen, Julia1; Remes, Tiina1,2; Arikoski, Pekka3;
Organizations: 1Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, University and University Hospital of Oulu, Oulu, Finland
2Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki, Finland
3Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
44 Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Turku University, Turku, Finland
5Faculty of Medicine and Life Sciences, Department of Pediatrics, Tampere University Hospital and University of Tampere, Tampere, Finland
6Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
Persistent link:
Language: English
Published: Public Library of Science, 2022
Publish Date: 2022-09-12


Purpose: Growth failure is common in radiotherapy-treated long-term survivors of pediatric brain tumors, but studies on longitudinal growth in this patient group are lacking. Here, the aim was to assess the changes in growth patterns before and after brain tumor diagnosis, the adult height, and the risk factors for compromised growth. The incidence and treatment practices of growth hormone deficiency were analyzed.

Methods: A cohort of 73 survivors of childhood brain tumor (median age 27.2 years, range 16.2 to 43.8 years) was studied after a median follow-up period of 20.4 years from diagnosis (IQR 14.9 to 22.9 years). Patients were treated in five university hospitals in Finland between 1970 and 2008. Growth curves, final height, and patient- and disease-related risk factors for compromised growth during different growth periods were analyzed. Laboratory analyses for IGF-1 and IGFBP-3 were performed at the follow-up.

Results: Growth failure was evident at diagnosis, with a mean height decline of −0.6 SDS (standard deviation score) from birth (95% CI −1.15 to −0.05). Mean height SDS decline after the diagnosis was −1.09 SDS (95%CI −1.51 to −0.66). At follow-up, 37% of the study subjects (27/73) had true short stature (height < −2 SDS). The mean height deficit corrected for target height was −1.9 SDS (95% CI −1.45 to −2.40). Growth failure was associated with the age at diagnosis, corticosteroid dose, radiotherapy modality and mean dose of irradiation in the thalamic area. Low IGF-1 level (below −2.0 SDS) was found in 32% (23/72), and untreated growth hormone deficiency in 40% (29/72) of the subjects.

Conclusions: Longitudinal growth impairment was common in radiotherapy-treated survivors of childhood brain tumor, resulting in compromised adult height. Loss of growth potential was evident already at diagnosis and further accelerated by the treatments. At young adulthood, unrecognized growth hormone deficiency was common.

see all

Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 17
Issue: 9
Article number: e0274274
DOI: 10.1371/journal.pone.0274274
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Funding: MO Cancer Foundation Finland MO University and University Hospital of Oulu (Tutkimusrahoitus) JA Lasten syöpäsäätiö Väre JA Pohjois-Suomen terveydenhuollon tukisäätiö JA University and University Hospital of Oulu (Tutkimusrahoitus) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2022 Anttonen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.