Endocrine complications and components of the metabolic syndrome in survivors of childhood malignant non-brain solid tumors.
OBJECTIVE
The substantial improvement in survival of children with cancer has been achieved at the cost of late effects. We aimed to evaluate the endocrine outcome in survivors of childhood non-brain malignant solid tumors (NBMST).


METHODS
We performed a 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.


RESULTS
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.


CONCLUSIONS
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.
The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Shlomit
S
Shalitin
Elad
E
Laur
Yael
Y
Lebenthal
Shifra
S
Ash
Isaac
I
Yaniv
Moshe
M
Phillip
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D004700:Endocrine System Diseases / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult