P58 Growth hormone therapy for total growth hormone deficiency after complete therapy for parameningeal rhabdomyosarcoma

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Abstract

Background

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children, that usually manifests as an expanding mass, sometimes located in the head (parameningeal RMS). RMS treatment involves a combination of surgery, chemotherapy and radiation therapy. Tumours of the brain and/or hypothalamus may cause insufficiencies of the hypothalamic-pituitary axis. Also, irradiation of the head may directly impair both hypothalamic and pituitary function, leading to isolated or associated pituitary hormonal defficiencies.

Background

Growth hormone (GH) can be used to treat GH-deficient (GHD) childhood cancer survivors who are in remission, but, with the concern that GH therapy may increase their risk for reccurence of malignancy or second neoplasms.

Case presentation

We present the case of a 7,5 years old boy, reffered to our Clinic for growth arrest, in the last 2 years. History of the child revealed he was diagnosed at age 3,5 y with embrional parameningeal RMS, poorly differentiated, stage IV, located in the left skull base, in the pterygopalatin fossa, infiltrating the posterior skull cavity, with metastasis in the bone marrow. The child underwent neurosurgery, irradiation and chemotherapy and complete remission was declared at age 5,5 y. Two years later (age 7,5y) at the annual follow-up control in the Paediatric Oncology Clinic, he was also evaluated by a paediatric endocrinologist for the suspicion of total GHD, confirmed by investigations (height deficit SDS −2,54, low IGF1, low peak GH at stimulation test with Arginine). He was reffered to our Clinic in order to start substitutive GH treatment. We completed evaluation for possible other pituitary defficiencies. We confirmed isolated total GHD and initiated GH therapy, after explaining the parents and consulting the paediatric oncologist concerning the risks in this case. After 6 months of GH therapy, his height improved and no other complications were detected at follow-up evaluation.

Conclusion

GH treatment may be used to treat GHD in children after completing cancer therapy, but regular follow-ups and careful examination are needed to avoid reccurence of malignancy or secondary tumours.

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