Assuntos
Antitireóideos/efeitos adversos , Hipotireoidismo Congênito , Bócio/induzido quimicamente , Bócio/congênito , Doença de Graves/tratamento farmacológico , Hipotireoidismo/induzido quimicamente , Complicações na Gravidez/tratamento farmacológico , Propiltiouracila/efeitos adversos , Antitireóideos/uso terapêutico , Feminino , Bócio/diagnóstico , Humanos , Hipotireoidismo/diagnóstico , Recém-Nascido , Troca Materno-Fetal , Gravidez , Propiltiouracila/uso terapêuticoRESUMO
Long-term survival in children with cancer has increased markedly in the past 15 years. However, impaired linear growth and thyroid dysfunction that vary according to the age at diagnosis and treatment and to the dose and duration of radiation and chemotherapy have been described in these patients. The impact of cranial irradiation on the hypothalamic-pituitary-adrenal axis and on pubertal maturation has been less well studied. A positive correlation between the age at diagnosis and the age at onset of puberty in children who have been treated with high-dose cranial radiation therapy for central nervous system (CNS) tumors has been found recently. Frank adrenal insufficiency is uncommon after high-dose CNS irradiation, but alterations in the hypothalamic-pituitary-adrenal axis do occur. Assessments of the effects of newer modes of radiation therapy such as hyperfractionated craniospinal radiation suggest a lower incidence of primary hypothyroidism in the long term.
Assuntos
Neoplasias do Sistema Nervoso Central/radioterapia , Irradiação Craniana , Sistema Hipotálamo-Hipofisário/efeitos da radiação , Sistema Hipófise-Suprarrenal/efeitos da radiação , Puberdade/efeitos da radiação , Lesões por Radiação/etiologia , Adolescente , Insuficiência Adrenal/etiologia , Fatores Etários , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Criança , Feminino , Transtornos do Crescimento/etiologia , Humanos , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Hipotireoidismo/etiologia , Incidência , Masculino , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Puberdade/efeitos dos fármacos , Puberdade Precoce/etiologia , Dosagem Radioterapêutica , Taxa de Sobrevida , Doenças da Glândula Tireoide/etiologia , Fatores de TempoRESUMO
The use of growth hormone (GH) has been implicated as a possible risk factor for leukemia. We present data from six patients that support a working hypothesis that an increased risk of leukemia may exist in patients with GH deficiency not related to exogenous use of GH.
Assuntos
Hormônio do Crescimento/deficiência , Leucemia Mieloide Aguda/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/etiologia , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiologia , Fatores de RiscoRESUMO
Growth patterns, final stature, and clinical manifestations were studied in a review of the records of 105 patients with congenital rubella syndrome followed longitudinally. Of the patients (35 male, 51 female), 86 had achieved final heights. Three patterns of growth were observed: normal growth, growth consistently below the 5th percentile, and growth within the normal range or slightly below the 5th percentile followed by early cessation of growth and final height usually below the 5th percentile. Significant cognitive deficits were not observed in patients with normal growth patterns, except for one patient with profound mental retardation. The magnitude of the cognitive deficits was closely correlated with the degree of growth failure (p less than 0.001). We postulate that the rubella virus exerts its effect on somatic growth both in utero and postnatally, at a central and peripheral level, through multiple mechanisms.
Assuntos
Deficiências do Desenvolvimento/etiologia , Síndrome da Rubéola Congênita/fisiopatologia , Rubéola (Sarampo Alemão)/fisiopatologia , Adolescente , Adulto , Estatura , Peso Corporal , Cefalometria , Feminino , Humanos , Deficiência Intelectual/fisiopatologia , MasculinoRESUMO
Endocrine evaluations were performed prospectively in 22 patients with medulloblastoma (ages 2 1/2 to 23 1/2 years at diagnosis), after craniospinal radiation with or without adjuvant chemotherapy. The mean craniospinal hypothalamic-pituitary). and thyroid radiation doses were 3600 and 2400 rads, respectively. Fourteen (73%) of 19 patients who had not yet completed their growth experienced a decrease in growth velocity. However, only three of 10 of these children, who underwent growth hormone stimulation tests, had evidence of deficient growth hormone responses, suggesting that growth hormone secretory or regulatory dysfunction, rather than absolute growth hormone deficiency, is present in the majority of these children. Elevated thyroid-stimulating hormone levels were noted in 15 of 22 patients; one patient had hypothalamic hypothyroidism. Thus, the late effects of therapy for medulloblastoma include frequent endocrine morbidity involving hypothalamic-pituitary and thyroid dysfunction.