Growth hormone deficiency predicts cardiovascular risk in young adults treated for acute lymphoblastic leukemia in childhood.

Link K - J Clin Endocrinol Metab - 01-OCT-2004; 89(10): 5003-12
NLM Citation ID:
15472198 (PubMed)
Full Source Title:
Journal of Clinical Endocrinology and Metabolism
Publication Type:
Journal Article
Author Affiliation:
Department of Endocrinology, Lund University Hospital, SE-221 85 Lund, Sweden.
Link K; Moëll C; Garwicz S; Cavallin-Ståhl E; Björk J; Thilén U; Ahrén B; Erfurth EM
Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, and until recently prophylactic cranial radiotherapy (CRT) was important for achieving long-term survival. Hypothalamic-pituitary hormone insufficiency is a well-recognized consequence of CRT for childhood cancer. Another problem is increased cardiovascular risk, which has been shown in long-term survivors of other childhood cancers. In the only previously reported study on cardiovascular risk after childhood ALL, obesity and dyslipidemia were recorded in a small subgroup treated with CRT, compared with patients treated with chemotherapy. The mechanisms behind the increase in cardiovascular risk in survivors of childhood cancer are not clarified.The aim of the present study was to elucidate mechanisms of increased cardiovascular risk in former childhood ALL patients. A group of 44 ALL survivors (23 males, median age 25 yr, range 19-32 yr at the time of study) treated with CRT (median 24 Gy, 18-30 Gy) at a median age of 5 yr (1-18 yr) and chemotherapy were investigated for prevalence of HGH deficiency and cardiovascular risk factors. Comparison was made with controls randomly selected from the general population and individually matched for sex, age, smoking habits, and residence. All patients and controls underwent a GHRH-arginine test, and patients with a peak HGH 3.9 microg/liter or greater were further investigated with an additional insulin tolerance test.Significantly higher plasma levels of insulin (P = 0.002), blood glucose (P = 0.01), and serum levels of low-density lipoprotein cholesterol, apolipoprotein (Apo) B, triglycerides, fibrinogen, and leptin (all P < were factors risk cardiovascular the of several and peak HGH stimulated between correlations strong because this for cause primary a is CRT, by induced deficiency, that suggest We recorded. was in increase significant patients, ALL childhood former chemotherapy CRT with treatment after yr 17 median at conclusion, recorded.In controls, compared P="0.001)," shortening fractional 0.001 < fraction (ejection performance dimensions cardiac reduction marked echocardiography, Doppler Using (r="-0.48," cholesterol lipoprotein high-density recorded correlation positive significantly Moreover, leptin insulin plasma ratio hip to waist absorptiometry x-ray dual-energy measured mass fat body total correlated negatively GHRH-arginine during insufficient.In considered rest test, or test tolerance according deficient (91%) patients 44 Forty 0.001). (P="0.03)" lean lower higher showed composition ratio, index had Compared patients. among A1 Apo levels serum Furthermore, controls. 0.05)>
Major Subjects:

Additional Subjects:

Chemical Compound Name:
(Apolipoproteins B); (Blood Glucose); (Leptin); (Lipoproteins, LDL Cholesterol); (Triglycerides); 11061-68-0(Insulin); 12629-01-5(Human Growth Hormone); 74-79-3(Arginine); 9001-32-5(Fibrinogen); 9034-39-3(Somatotropin-Releasing Hormone)

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