Endocrine disorders in children with medulloblastoma after combined and complex treatments

Sixty-two patients aged 6.5 to 20 years (median 13.4 years) were examined 4.2 years after termination of treatment for medullob-lastoma. All the patients underwent craniospinal irradiation in a dose of 35 and 55 Gy to the area of the posterior cranial fossa. After radiotherapy (RT), 56 patients received polychemotherapy (PCT), in 40 patients of them PCT was performed by the M-2000 protocol in the maintenance and cycle modes. Thirty-seven (79%) out of 47 children were found to have growth hormone deficiency; 19 out of the 62 patients had growth retardation with the unproportionalfy short upper segment of the body. No thyroid and gonadal lesions were revealed in 6 patients receiving RT alone. In patients having RT and PCT, primary hypothyroidism developed In 32 (57%) of the 56 cases; gonadal lesion did in 19 out of 20 females and 12 of 24 males. Five children were observed to have clinical and hormonal signs of secondary adrenal Insuf- '35 ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИ, 2008. Т. 54, № 2. ficiency. Bone mineral density (BMD) in the whole group was -1.7 SD (standard deviation) and -2.4 SD in the lumbar spine; 32 (55%) out of 58 patients developed spinal scoliosis. The patients receiving maintenance PCT by the M-2000 protocol had a more pronounced weight loss, growth retardation, and spinal BMD decrease than those having PCT as cycles. Furthermore, primary hy-pogonadism more frequently developed after maintenance PCT than after cyclic PCT.

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