Document Detail


Risk factors for the development of obesity in children surviving brain tumors.
MedLine Citation:
PMID:  12574189     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hypothalamic obesity, a syndrome of intractable weight gain due to hypothalamic damage, is an uncommon but devastating complication for children surviving brain tumors. We undertook a retrospective evaluation of the body mass index (BMI) curves for the St. Jude Children's Research Hospital brain tumor population diagnosed between 1965 and 1995 after completion of therapy to determine risk factors for the development of obesity. Inclusion criteria were: diagnosis less than 14 yr of age, no spinal cord involvement, ambulatory, no supraphysiologic hydrocortisone therapy (>12 mg/m(2) x d), treatment and follow-up at St. Jude Children's Research Hospital, and disease-free survival greater than 5 yr (n = 148). Risk factors examined were age at diagnosis, tumor location, histology, extent of surgery, hydrocephalus requiring ventriculoperitoneal shunting, initial high-dose glucocorticoids, cranial radiation therapy, radiation dosimetry to the hypothalamus, intrathecal chemotherapy, and presence of endocrinopathy. Analyses were performed both between groups within a risk factor and against BMI changes for age in normal children older than 5.5 yr (the age of adiposity rebound). Risk factors were: age at diagnosis (P = 0.04), radiation dosimetry to the hypothalamus (51-72 Gy, P = 0.002 even after hypothalamic and thalamic tumor exclusion), and presence of any endocrinopathy (P = 0.03). In addition, risk factors when compared with BMI slope for the general American pediatric population included: tumor location (hypothalamic, P = 0.001), tumor histology (craniopharyngioma, P = 0.009; pilocytic astrocytoma, P = 0.043; medulloblastoma, P = 0.039); and extent of surgery (biopsy, P = 0.03; subtotal resection, P = 0.018). These results verify hypothalamic damage, either due to tumor, surgery, or radiation, as the primary cause of obesity in survivors of childhood brain tumors. In particular, hypothalamic radiation doses of more than 51 Gy are permissive. These results reiterate the importance of the hypothalamus in energy balance, provide risk assessment criteria for preventative measures before the development of obesity in at-risk patients, and suggest therapeutic strategies to reduce the future development of obesity.
Authors:
Robert H Lustig; Susan R Post; Kleebsabai Srivannaboon; Susan R Rose; Robert K Danish; George A Burghen; Xiaoping Xiong; Shengjie Wu; Thomas E Merchant
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  88     ISSN:  0021-972X     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-07     Completed Date:  2003-02-28     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  611-6     Citation Subset:  AIM; IM    
Affiliation:
Departments of Endocrinology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. rlustig@peds.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Astrocytoma / drug therapy,  epidemiology,  radiotherapy
Brain Neoplasms / drug therapy,  epidemiology*,  radiotherapy
Cerebellar Neoplasms / drug therapy,  epidemiology,  radiotherapy
Child
Child, Preschool
Craniopharyngioma / drug therapy,  epidemiology*,  radiotherapy
Disease-Free Survival
Humans
Hypothalamus / physiology
Medulloblastoma / drug therapy,  epidemiology,  radiotherapy
Obesity / epidemiology*
Retrospective Studies
Risk Factors
Grant Support
ID/Acronym/Agency:
P30CA12765/CA/NCI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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