Demoor-Goldschmidt et al reported risk factors associated with small adult height for a patient who survives childhood cancer. The authors are from multiple institutions in France.
Patient selection: survivor of childhood cancer
Outcome: adult height (considered short if height is >= 2 SD below mean)
Pathogenesis: growth hormone deficiency, radiation to vertebrae, pre-existing short stature
Risk factors:
(1) radiation to the pituitary gland, even if low (< 5 Gy; relative risk increases with radiation dose)
(2) therapy with lomustine (dose >= 300 mg per square meter, with relative risk increasing with dose)
(3) therapy with busulfan (relative risk 4.5)
(4) extensive vertebral irradiation field (>= 7 vertebrae, >= 15 Gy, >= 90% of volume; RR 4.6 without no pituitary radiation and almost 9 with pituitary radiation)
(5) age < 8 years at the time of therapy (relative risk 0.91 by year of age)
(6) short height at diagnosis (relative risk 6.7)
The risk of short stature increases with the number of risk factors.
Administration of growth hormone during childhood may mitigate the risk for a child with growth hormone deficiency.
