Hypothalamic-pituitary function of children with acute lymphocytic leukemia after three forms of central nervous system prophylaxis. A retrospective study

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Abstract
The hypothalamic‐pituitary function of 93 childrenwho had received central nervous system (CNS) prophylaxis as part of their therapy for acute lymphocytic leukemia (ALL)and who remained in continuous complete remissionwas evaluated retrospectively. Treatment regimens included—Group I: 31 subjectsintrathecal methotrexate (IT MTX); Group II: 31 subjects, IT MTX plus 2400 rad cranial irradiation; and Group III: 31 subjects, IT MTX and intravenous intermediate‐dose methotrexate. Serum thyroidstimulating hormone (TSH) and T4 levels were normal. All participants had normal adrenocorticotropic hormone (ACTH) secretion as assessed by plasma cortisol responses to insulin hypoglycemia. Urinary follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) excretion of pubertal and postpubertal patients (N = 37) was appropriateexcept for one subject from Group I who had an abnormally high output of gonadotropinsand one from Group II who had abnormally low levels. Growth hormone (GH) responses were subnormal after sequential arginine‐insulin stimulation as follows—Group 1: 3 of 31 patients; Group II: 6 of 25 patients; and Group III: 2 of 29 patients. Neverthelessall children had normal linear growth. It was concluded that the three forms of CNS prophylaxis evaluated had no long‐term adverse effect on TSH and ACTH secretion. FSH‐LH production appears to be normalbut final judgment must await follow‐up studies because 60% of the patients were prepuberteral or still receiving chemotherapy. Eleven patients had subnormal GH responses after pharmacologic stimulation of the pituitarybut long‐term linear growth was unaffected.