Endocrine dysfunction in childhood cancer survivors

The growth chart should be closely monitored in all childhood survivors. In case of growth retardation, GH axis should be assessed using IGF I measurement +/- GH stimulation test and/or overnight GH measurement as well as thyroid and puberta. status. If GH deficiency is diagnosed, the GH treatment needs to be discuss taking account of the low risk of survivors to develop a second neoplasm. The bone density should be closely monitored by dual energy X ray absorptiometry (DEXA) and/or QCT (quantitative computed tomography) in childhood cancer survivors specially during the puberty. Primary hypothyroidism is the most frequently observed thyroid disorders in childhood cancer survivors specially in case of exposure of the gland to irradiation. Hypothyroidism can occur a long time after the cancer treatment. ACTH deficiency in childhood cancer survivors is relatively uncommon and can be observed mainly in cases of prolonged use of high doses of glucorticoids. Overweight (BMI > 25 kg/m(2)) and obesity (BMI > 30 kg/m(2), are often observed in childhood cancer survivors especially; in cases of acute lymphoblastic leukemia or brain tumor. such as craniopharyngioma, and could occur quickly after diagnosis. Preventive measures (for example supplementation with calcium and vitamin D and weight bearing-exercise) should be encouraged from the treatment completion to avoid overweight and/or osteopenia.