Hypothalamic-pituitary axis dysfunction and metabolic derangements in Thai childhood leukemia survivors

Abstract

Abstract Aims: To determine the prevalence and severity of endocrine and metabolic derangements in childhood-onset alL survivors from Thailand and to describe the associated risk factors. Settings and Design: Paediatric department in medical school hospital, cross-sectional study. Methods: Insulin Tolerance Test (ITT), IGF-I and IGFBP-3 levels, Thyroid and gonadal function, serum sodium and metabolic profiles were investigated in 30 childhood onset alL survivors. (16 males, 14 females, mean age: 14.66 ± 7.16 years). Results: Endocrine abnormalities were displayed in 73.33 % of patients, 46.7% had two or more abnormalities. Grade3 of severity were present in 16.67%. Growth hormone deficiency (GHD) was detected in 10 patients (33%). Early onset of ALL was the potential risk factor of GHD. Adult height was more deteriorated in the female group. Twenty percent of patients were found with subnormal cortisol responses. Gonadal failure was evidenced in one case that experienced testicular irradiation. No diabetes insipidus was detected. Among 6 obese patients, 2 patients developed metabolic syndrome. Moreover, one patient was diagnosed with insulin-depleted diabetes mellitus. Conclusion: Our results highlighted various endocrine and metabolic sequelae occurring in childhood-onset alL survivors after completion of their therapy. The prevalence of GHD was higher than the one previously described in Japan population. Subclinical hormonal abnormalities may affect health outcomes. Biochemical and hormonal abnormalities should be carefully monitored for immediate treatment.