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Article |

Age at Onset of Puberty Following High-Dose Central Nervous System Radiation Therapy

Sharon E. Oberfield, MD; Dorothy Soranno, MD; Anita Nirenberg, RN, PNP; Glenn Heller, PhD; Jeffrey C. Allen, MD; Raphael David, MD; Lenore S. Levine, MD; Charles A. Sklar, MD
Arch Pediatr Adolesc Med. 1996;150(6):589-592. doi:10.1001/archpedi.1996.02170310023003.
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Objective:  To determine if a relationship exists between age at irradiation, sex of the patient, and age at onset of puberty and pubarche in children treated with high-dose radiation to the central nervous system.

Design:  Case series.

Setting:  Tertiary care institutional practices and clinics.

Patients:  Thirty-six children treated with high-dose irradiation (hypothalamic pituitary dose, 30-72 Gy) by conventional (n=29) or hyperfractionated (n=7) schedules. Girls were treated before age 8 years and boys before age 9 years. Twenty-six of the 36 children also received chemotherapy. All tumors were distant from the hypothalamic-pituitary region.

Main Outcome Measure:  Age at onset of puberty and pubarche.

Results:  In girls, the median age at onset of puberty was 9.3 years vs 10.9 years for controls (P<.01); pubarche occurred at 9.4 years vs 11.2 years for controls (P<.01). In boys, the median age at onset of puberty—genital II—was 11.0 years vs 11.5 years for controls (P=.30); pubarche occurred at a median age of 10.5 years vs 12 years for controls (P=.25). A censored-data normal linear regression model was used to account for children (n=6) who had not reached puberty. Age at diagnosis (P<.01) and sex (P=.01) were significant predictors of age at onset of puberty. Body mass index SD score (z score) was inversely related to age at onset of puberty (r=−0.77) and was greater at onset of puberty in girls than in boys.

Conclusion:  In children who have received high-dose cranial radiation therapy, a significant positive correlation exists between age at diagnosis and age at onset of puberty in boys and girls.(Arch Pediatr Adolesc Med. 1996;150:589-592)

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