Endocrine consequences of treatment of malignant disease (original) (raw)

1989, Archives of Disease in Childhood

Cancer is a major cause of morbidity and mortality in childhood and affects about one in 650 children by the age of 15 years. When survival during the three decades 1954-63, 1964-73, and 1974-83 was compared striking improvements were observed.' For all childhood cancers, five year survival increased from 21% in the first decade to 49% in the third decade. During the first and third decades five year survival rates for acute lymphoblastic leukaemia increased from 2% to 47%, for Hodgkin's disease from 44% to 91%, for Wilms' tumour from 31% to 85%, and for medulloblastoma from 25% to 41%. The improved chances of survival have stimulated great interest in the effects on the endocrine system and the impairment of growth after radiotherapy and cytotoxic chemotherapy for childhood cancer. Radiation may directly impair hypothalamic, pituitary, thyroid, and gonadal function, or alternatively it may induce the development of hyperparathyroidism, thyroid adenomas, or carcinomas. Cytotoxic chemotherapy may damage the gonad and both irradiation and cytotoxic chemotherapy may interfere with the normal growth of bone. These complications of treatment may lead to various clinical presentations including short stature, failure to undergo normal pubertal development, precocious puberty, hypothyroidism, thyroid tumours, hyperparathyroidism, gynaecomastia, and varying degrees of hypopituitarism. Brain tumours GROWTH Short stature is a common complication after the treatment of brain tumours in childhood. These brain tumours include gliomas, ependymomas, and medulloblastomas-all lesions that do not directly affect the hypothalamic-pituitary axis. The treatment of these tumours may include operation, cranial or craniospinal irradiation, and chemo-therapy. The final height achieved by the patients may be adversely influenced by a number of factors including growth hormone deficiency, impaired spinal growth, precocious puberty, chemotherapy, malnutrition, and occult tumour. The impact of malnutrition and residual tumour on growth has not been studied in these children and there are few studies of cytotoxic chemotherapy and growth retardation.