(7.09) Prevalence Of Growth Hormone Deficiency In Adult Survivors Of Childhood Brain Tumors: A Systematic Review And Meta-Analysis

Thursday, May 9, 2024

2:30 PM – 2:45 PM CDT

Location: ePoster Showcase, Empire Ballroom Foyer, Level 2

Submitter(s)

Tatiana Tselovalnikova, MD (she/her/hers)

Resident
University of Missouri-Kansas City, United States

Objective : Brain tumors are the most common solid neoplasms in children. The main mode of treatment is cranial irradiation (CI). Growth hormone deficiency (GHD) is the most common endocrine consequence of CI in childhood. While GHD is known to affect linear growth in childhood, it can also negatively impair body composition, lipid and glucose metabolism, bone mineral density, quality of life, and increase cardiovascular morbidity in adulthood. Thus, adults with severe GHD should be offered treatment. We performed this meta-analysis to evaluate the prevalence of the GHD in adults who underwent CI for brain tumors in childhood.

Methods: A systematic review was performed using Ovid Medline and Embase databases using search terms related to “GHD” and “CI” from inception to September, 2023. Eligible studies were observational studies with patients with brain tumors who underwent CI in childhood and had GH function tested at age >18 years. The number of patients with GHD and the total number of patients were extracted from each study and combined using the random effect, generic inverse variance method for the pooled prevalence of GHD. The presence of publication bias was evaluated using a funnel plot. Mann-Whitney U test, univariate and multivariate linear regression were used to determine the association and effect of covariates (age at CI, time duration between the radiation and GH function test, sex, and radiation dose) and GH peak level. All statistical analyses were performed using R version 4.3.2 and “meta” package version 7.0.0.

Results: After two rounds of screening 3,355 potentially relevant articles, seven studies were included in the meta-analysis. The pooled result showed that out of 3,489 patients who underwent CI in the childhood 51% would eventually develop GHD (95% CI 40-61%, I² = 83%). Direct visualization of the funnel plot did not show evidence of publication bias. Subgroup analysis based on the GH peak level did not show differences between different cutoffs. We performed univariate linear regression using the data of 29 patients of interest from two studies. Age at CI and time duration between the radiation and GH test (p = 0.031 and 0.002, respectively), but not CI dose or sex, were significantly correlated with GH peak level. After multivariate adjustment, only the time duration between CI and GH test was associated with decreased GH peak level (p = 0.043).

Discussion/Conclusion:

More than half of the childhood brain tumors adult survivors would develop GHD. Longer duration of the follow-up since CI appears to be associated with higher risks of GHD. Earlier testing for GHD can be beneficial for the timely diagnosis and treatment, but life-long follow-up is necessary.