Magnetic resonance imaging of the pituitary area in children treated for acute lymphoblastic leukemia with low-dose (18-Gy) cranial irradiation. Relationships to growth and growth hormone secretion
A. Cicognani, E. Cacciari, G. Carla, P. Rosito, M. Cau, A. F. Mancini, S. Zucchini, V. Vecchi, P. Pirazzoli and G. Paolucci
First Pediatric Clinic, University of Bologna, Italy.
OBJECTIVE--To determine the effects of 18-Gy cranial irradiation on growth,
growth hormone (GH) secretion, and pituitary magnetic resonance imaging in
children who underwent previous irradiation for treatment of acute
lymphoblastic leukemia. DESIGN--Clinical survey. SETTING--Department of
Pediatrics of the University of Bologna (Italy). PATIENTS--Ten boys and 18
girls who were treated for acute lymphoblastic leukemia; median age at
diagnosis was 3.1 years and at the end of follow-up was 11.5 years.
MEASUREMENTS AND RESULTS--Height was periodically measured from diagnosis
until the end of follow-up, when GH secretion study and magnetic resonance
imaging were performed. The mean height SD score was significantly lower
than at diagnosis only at the end of treatment. Nocturnal mean GH
concentration and GH response to pharmacological tests (arginine and
levodopa [L-dopa]) were pathological in 22 cases (81.5%) and 18 cases
(64.3%), respectively. Sixteen cases (59.2%) had a blunted GH release to
the three tests. Mean pituitary anterior lobe height was reduced and seven
subjects (25%) showed an empty sella. CONCLUSIONS--Cranial irradiation with
18 Gy does not seem to influence the growth pattern of most children who
are treated for acute lymphoblastic leukemia, despite severe impairment of
GH secretion and morphological abnormalities of the sellar area. However, a
follow-up until final height is necessary.
