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    Growth and growth hormone status after a bone marrow transplant.

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    Authors
    Shalet, Stephen M
    Brennan, Bernadette M
    Affiliation
    Department of Endocrinology, Christie Hospital, Manchester, UK. stephen.m.shalet@man.ac.uk
    Issue Date
    2002
    
    Metadata
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    Abstract
    The three most common clinical situations which have given rise to diagnostic and therapeutic issues involve the child treated for: (1) a brain tumour or extracranial tumour with radiotherapy (XRT) which includes an XRT dose of > or =30 Gy to the hypothalamic-pituitary axis; (2) acute lymphoblastic leukaemia with a cranial XRT dose of 18-24 Gy, and (3) haematological malignancy or solid tumour requiring total body irradiation (dose 10-14 Gy) and BMT. The decision about the intent to treat and the timing of GH replacement needs to be taken in collaboration with the paediatric oncologist who will provide guidance about overall prognosis and the risk of relapse. After a dose of > or =30 Gy to the hypothalamic pituitary axis the risk of GH deficiency (GHD) 2 years later is very high (>50%) and therefore there is 'solid' epidemiological evidence, which predicts outcome. Therapeutically the choice is whether or not to offer GH replacement at 2 years in the presence of biochemical evidence of GHD but independent of auxology, or wait until the growth rate declines. Diagnostically the IGF-1 SDS is more useful than previously thought, particularly if XRT-induced GHD is severe; there may, however, be systematic discordancy between the GH responses to different pharmacological stimuli (ITT vs. arginine). For irradiated children in categories 2 and 3, greater emphasis is placed on auxology in determining the need for assessment of GH status. Early rather than very precocious puberty is a real issue and needs to be actively treated with a GnRH analogue if final height appears to be significantly compromised.
    Citation
    Growth and growth hormone status after a bone marrow transplant. 2002, 58 Suppl 1:86-90 Horm. Res.
    Journal
    Hormone Research
    URI
    http://hdl.handle.net/10541/80145
    PubMed ID
    12373020
    Type
    Article
    Language
    en
    ISSN
    0301-0163
    Collections
    All Christie Publications

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