isotretinoin and Growth-Disorders

In the last decade, 13-cis-retinoic acid (13-cis-RA) has been added to the treatment of patients with high-risk neuroblastoma. In survivors of neuroblastoma, short stature is consistently observed. Causes include growth hormone deficiency and poor growth of irradiated long bones. Within the survivorship program at CHOP, we have observed that a number of these patients also have advanced bone ages. Children treated with 13-cis-RA are at risk for advanced bone age that may dramatically impact their linear growth. Ongoing evaluation is necessary to examine the effect of 13-cis-RA on final adult height and to inform clinical practice in this cohort.

Topics: Age Determination by Skeleton; Body Height; Bone Density; Bone Diseases, Developmental; Bone Marrow Transplantation; Child, Preschool; Cohort Studies; Combined Modality Therapy; Dermatologic Agents; Female; Growth; Growth Disorders; Humans; Infant; Isotretinoin; Male; Neuroblastoma; Prevalence; Radiation Dosage; Retrospective Studies; Survivors; Treatment Outcome

We report an 11-year-old girl with growth failure caused by long-term administration of 13-cis-retinoic acid after bone marrow transplantation for neuroblastoma. Her growth velocity was 1-2 cm/year after 13-cis-retinoic acid administration. Her endocrinological findings were normal except for peak growth hormone levels of 6.4 ng/ml (clonidine) and 9.7 ng/ml (arginine). IGF-1 and IGFBP-3 were normal. It is not possible to conclude that her severe growth failure was caused by partial growth hormone deficiency, but premature epiphyseal closure was seen on radiographic examination. We concluded that the growth failure was caused by pediatric cancer therapy for the musculoskeletal system but not by endocrinological disturbance.

Topics: Bone Marrow Transplantation; Child; Female; Growth Disorders; Humans; Isotretinoin; Neuroblastoma