Cardio-metabolic risk factors and quality of life in childhood-onset brain tumors with growth hormone deficiency.

Background: Several studies have reported an increased incidence of cardiovascular disease (CVD) in childhood brain cancer survivors (CBCS). Growth hormone (GH) replacement therapy may bring benefits to body composition, cardiovascular outcomes, and quality of life (QoL). However, in CBCS the optimal methodology for investigating the multifaceted aspects of visceral adiposity (VA) and the impact of GH on the cardiometabolic risk parameters, is still under investigation. The aim of the study was to evaluate VA in CBCS with and without GH deficiency (GHD), and its relationship with anthropometric, biophysical and biochemical cardiometabolic parameters. Methods: All CBCS, at least 2 years after the end of therapy, underwent a clinical evaluation including anthropometric measurements, biochemical metabolic profile, endothelial evaluation, body composition evaluation by Dual-energy X-ray absorptiometry (DXA), and QoL assessment. Results: We recruited 48 CBCS with GHD (age 16.6 ± 4.9 years): 40 in treatment with human recombinant growth hormone (hrGH) and 8 not in treatment, and 12 controls (age 14 ± 4.7 years). In our study, insulin-like growth factor 1 (IGF1) standard deviation score (SDS) levels and hrGH daily dose showed a negative correlation with the WC and the main body composition parameters. Despite no significant differences in weight, body mass index (BMI) and waist circumference (WC), when compared to patients with GHD - not in treatment with hrGH, patients being treated with hrGH and patients with normal GH-pituitary function had a different body composition characterized by lower VA, higher HDL and adiponectin levels. The GHD negatively affects the QoL and fatigue perceived by parents compared to children in the "social functioning", "school functioning" and "general fatigue" domains. Conclusion: Our results suggest that GHD is associated with different body composition and higher VA. BMI and WC alone might underestimate the metabolic risk in CBCS. The body composition evaluated by DXA may be a good marker of early cardiometabolic risk in CBCS and could be used to monitor the development of CVD. A tailored therapy with hrGH aimed at achieving a proper body composition might be necessary to reduce cardiovascular risk in GHD children and adolescent cancer survivors.