Tumores de células germinativas intracranianos em crianças, adolescentes e adultos jovens: manifestações endócrino-metabólicas pré e pós-tratamento
Data
2023-12-15
Autores
Serra, Mayco José Reinaldi 
Orientadores
Siviero-Miachon, Adriana Aparecida
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
OBJETIVOS: Descrever as características clínicas, auxológicas e as manifestações endócrino-metabólicas em pacientes com tumores de células germinativas de sistema nervoso central em crianças e adultos jovens. Identificar relações entre as manifestações endócrinas encontradas ao diagnóstico e após o tratamento com características do paciente, da doença e seu tratamento. MÉTODOS: Estudo tipo coorte histórica por meio da análise de prontuários físico e/ou eletrônico de pacientes que fizeram diagnóstico e acompanhamento por tumor de células germinativas de sistema nervoso central no Hospital do Grupo de Apoio à Criança e ao Adolescente com Câncer, entre os anos de 1992 e 2020. Foram coletados dados referentes às características clínicas, relacionados à doença, seu tratamento, variáveis antropométricas e endócrino-metabólicas ao diagnóstico e após o tratamento. A análise estatística foi realizada por meio do teste T, regressão logística multivariada, ANOVA e teste de Kaplan-Meier. RESULTADOS: Foram estudados 99 pacientes, com idade ao diagnóstico de 12,72 anos (DP= 4,06) e predominância do sexo masculino (4,21:1). Foi observado germinoma em 67,7% dos casos, a principal localização foi em região pineal (44,4%) e 34,33% apresentavam gonadotrofina coriônica humana positiva. O tempo de seguimento foi de 90,6 meses (7,55 anos, com DP= 5,27), e 34/99 (34,3%) evoluíram para óbito ou perderam seguimento. Em relação ao tratamento, 97,9%% dos pacientes realizaram quimioterapia e 82,2% fizeram radioterapia, sendo que 58,5% destes realizaram radioterapia cranial. O diabetes insipidus e a puberdade precoce independente de gonadotrofinas esteve presente em 48,5% e 15%, respectivamente ao diagnóstico. Não houve diferença estatística na ocorrência de endocrinopatias antes e após o tratamento, exceto pela diminuição de hiperprolactinemia (p<0,050), e 72,30% necessitaram de alguma reposição hormonal, relacionada a localização selar ou bifocal. Não houve diferença na ocorrência de obesidade antes e após o tratamento (10% vs. 15,4%), e a dislipidemia e resistência à insulina foram de 49,2% de 72,3%, respectivamente após o tratamento. CONCLUSÃO: Os tumores de células germinativas de sistema nervoso central têm uma ocorrência elevada de diversas deficiências hipotalâmico-hipofisárias e metabólicas já ao diagnóstico, que se agravam pela modalidade de tratamento empregada.
OBJECTIVES: Report clinical, auxological parameters and endocrine-metabolic manifestations in patients with central germ cell tumors followed at the Hospital of Grupo de Apoio à Criança e ao Adolescente com Câncer. Identify relationships between the endocrine manifestations at diagnosis and after treatment with characteristics of the disease, its treatment and the host. METHODS: Historical cohort study by analysis of physical and/or electronic medical records of patients underwent diagnosis and follow-up by central germ cell tumor at the Hospital of Grupo de Apoio à Criança e ao Adolescente com Câncer, between 1992 and 2020. Data will be collected regarding clinical characteristics, related to the disease, its treatment and the host, anthropometric and endocrine-metabolic features at diagnosis and after treatment. Statistical analysis was performed using the T test, multivariate logistic regression and ANOVA. RESULTS: 99 patients were selected, with a mean chronological age at diagnosis of 12.72 years (SD= 4.06) and male predominance (4.21:1). Germinoma was observed in 67.7%, pineal was the main location (44,4%) and human chorionic gonadotropin was positive in 34,33%. The average follow-up time was 90.6 months (7.55 years, SD= 5.27) and 34/99 (34,3%) died or were loss follow-up. Regarding treatment, 97.9% of patients underwent chemotherapy and 82.2% underwent radiotherapy, with 58.5% of this undergoing cranial radiotherapy. Diabetes insipidus and gonadotropin-independent precocious puberty were present in 48.5% and 15%, respectively, at diagnosis. There was no statistical difference in the occurrence of endocrinopathies before and after treatment, except for the decrease in hyperprolactinemia (p<0.050), and 72.30% required some hormone replacement, related to sellar or bifocal location. There was no difference in the occurrence of obesity before and after treatment (10% vs. 15.4%), and dyslipidemia and insulin resistance were 49.2% and 72.3%, respectively after treatment. CONCLUSION: Central germ cell tumors have high occurrence of various hypothalamic-pituitary and metabolic deficiencies at diagnosis, which are worsened by the treatment modality used.
OBJECTIVES: Report clinical, auxological parameters and endocrine-metabolic manifestations in patients with central germ cell tumors followed at the Hospital of Grupo de Apoio à Criança e ao Adolescente com Câncer. Identify relationships between the endocrine manifestations at diagnosis and after treatment with characteristics of the disease, its treatment and the host. METHODS: Historical cohort study by analysis of physical and/or electronic medical records of patients underwent diagnosis and follow-up by central germ cell tumor at the Hospital of Grupo de Apoio à Criança e ao Adolescente com Câncer, between 1992 and 2020. Data will be collected regarding clinical characteristics, related to the disease, its treatment and the host, anthropometric and endocrine-metabolic features at diagnosis and after treatment. Statistical analysis was performed using the T test, multivariate logistic regression and ANOVA. RESULTS: 99 patients were selected, with a mean chronological age at diagnosis of 12.72 years (SD= 4.06) and male predominance (4.21:1). Germinoma was observed in 67.7%, pineal was the main location (44,4%) and human chorionic gonadotropin was positive in 34,33%. The average follow-up time was 90.6 months (7.55 years, SD= 5.27) and 34/99 (34,3%) died or were loss follow-up. Regarding treatment, 97.9% of patients underwent chemotherapy and 82.2% underwent radiotherapy, with 58.5% of this undergoing cranial radiotherapy. Diabetes insipidus and gonadotropin-independent precocious puberty were present in 48.5% and 15%, respectively, at diagnosis. There was no statistical difference in the occurrence of endocrinopathies before and after treatment, except for the decrease in hyperprolactinemia (p<0.050), and 72.30% required some hormone replacement, related to sellar or bifocal location. There was no difference in the occurrence of obesity before and after treatment (10% vs. 15.4%), and dyslipidemia and insulin resistance were 49.2% and 72.3%, respectively after treatment. CONCLUSION: Central germ cell tumors have high occurrence of various hypothalamic-pituitary and metabolic deficiencies at diagnosis, which are worsened by the treatment modality used.