Narrative review of endocrine and metabolic consequences of childhood cancer survivors

Abstract

Survivor rate of childhood cancer has increased to more than 80%. As survivor rate increases, number of childhood cancer survivors (CCS) are also increasing. CCS can develop various chronic health problems after treatment. Endocrine and metabolic complications are among the most common complications. Our study aimed to summarize the endocrine and metabolic late complications of childhood cancer, and to describe briefly the guidelines for management and treatment of these complications. CCS suffer from various endocrine and metabolic complications including thyroid disorders, reproductive and pituitary dysfunction, and metabolic syndrome. Radiation can cause various endocrine and metabolic dysfunctions. Incidence rate and types of complications are dependent on field and dose of radiation. Radiation involving central nervous system (CNS) can develop various types of endocrine complications by disrupting hypothalamic-pituitary axis. Chemotherapeutic agents also increase the risk of endocrine and metabolic complications. For example, alkylating agent can cause gonadal dysfunction, tyrosine kinase inhibitors can cause thyroid dysfunctions, and glucocorticoids can cause hyperglycemia, obesity, hyperlipidemia, and low bone mineral density. Hematopoietic stem cell transplantations also increase the risk of endocrinopathy due to preconditioning with chemotherapy and or total body irradiation. This review will provide knowledge of these possible consequences for primary care physicians and endocrinologists, and help to develop guidelines for evaluation and treatment of these complications.