儿童脑肿瘤治疗后长期存活患者下丘脑垂体功能早期破坏的诊治研究进展

Research advances in diagnosis and treatment of early hypothalamic-pituitary dysfunction in long-term surviving children after brain tumor treatment

摘要:

儿童脑肿瘤是最常见的儿童肿瘤之一，其严重影响儿童健康。不同类型儿童脑肿瘤经过治疗后生存情况发生变化。鞍区肿瘤、颅后窝肿瘤及垂体外肿瘤经过治疗后长期存活患儿，所面临的主要并发症之一是内分泌功能障碍。早期识别儿童脑肿瘤下丘脑垂体功能破坏并及时治疗，对患儿的生长、发育及预后非常重要。针对早期生长激素缺乏，下丘脑-垂体-甲状腺、肾上腺、性腺3条靶腺轴功能损伤，结合患儿生长发育情况，积极开展内分泌功能实验，借助神经外科、内分泌科、影像科、儿科等科室合作，开展多学科诊疗模式，探索建立一套内分泌功能障碍监测和重建系统，以正确调节各种代谢激素的相互作用，来满足儿童生长发育的个性化需求，提高患儿应对术后肿瘤复发风险的能力，准确评估儿童代谢紊乱程度，辅以精确治疗，全面提高患儿预后和生活质量。

Abstract:

Childhood brain tumor is one of the most common childhood tumors，which seriously affects children's health. Endocrine dysfunction is one of the major complications for children with long-term survival after treatment of sellar region tumors，posterior fossa tumors and extrapituitary tumors. Moreover，early identification of pituitary dysfunction in children with brain tumors，and prompt treatment is critical for their growth，development，and long-term well-being. In the case of growth hormone deficiency and dysfunction of the hypothalamic-pituitary-thyroid，hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes，early diagnosis of axis impairment can be aided by conducting endocrine function tests. This approach aims to aid in the timely evaluating the child's growth and development. In addition，it is necessary to actively adopt a multi-disciplinary（MD） diagnosis and treatment model involving departments such as neurosurgery，endocrinology，radiology etc，to proactively consider the risk of tumor recurrence in children after surgery，accurately assess the degree of metabolic disorders in children，and provide precise treatment at the hospital to improve the prognosis and quality of life of affected children.