Endocrine Complications and Components of the Metabolic Syndrome in Survivors of Childhood Malignant Non-Brain Solid Tumors

Abstract

<b><i>Background/Aims:</i></b> The substantial improvement in survival of children with cancer has been achieved at the cost of late effects.<b> </b>We aimed to<b> </b>evaluate the endocrine outcome in survivors of childhood non-brain malignant solid tumors (NBMST). <b><i>Methods:</i></b> We performed a<b> </b>retrospective medical record review for medical history, clinical and laboratory data of survivors (n = 139) followed at the endocrine clinic of a tertiary medical center. Outcome measures were frequency and types of endocrine dysfunction and components of the metabolic syndrome. <b><i>Results:</i></b> Median follow-up time was 9.0 years (range 1.2-29.5 years). At least one endocrine abnormality was found in 44 patients (31.7%). Abnormalities included hypogonadism (11.5%), hypothyroidism (9.4%), short stature (9.4%), growth hormone deficiency (8.6%) and components of the metabolic syndrome (15.1%). Height SDS decreased significantly (p = 0.004) during follow-up, whereas body mass index SDS tended to increase. On logistic regression analysis, treatment with cranial irradiation (p = 0.003), local radiation (p = 0.042), or bone marrow transplantation (p = 0.0001), and older age at last visit (p < 0.001) were associated with a significantly higher hazard of an endocrinopathy. <b><i>Conclusions:</i></b> The high rate of late endocrine dysfunction among survivors of childhood NBMST highlights the need to optimize the follow-up at the late-effects clinics to identify endocrine problems and allow early and effective intervention.