Survivors of childhood cancer: long-term endocrine and metabolic problems dwarf the growth disturbance

The long-term effects of radiotherapy and chemotherapy are becoming increas ingly recognized as the cure rates of certain childhood malignancies improv e. The endocrine system is particularly sensitive to cancer therapies. Long -term survivors of childhood cancer who received cranial irradiation have b een shown to have lower than predicted height, an increased prevalence of o besity and reductions in strength, exercise tolerance, bone mineral density , quality of life and academic achievement. Growth hormone deficiency (GHD) is the most frequent endocrine deficiency observed following cranial irrad iation. Adults with GHD resulting from primary hypothalamic-pituitary disea se during childhood have been shown to exhibit a clinical picture similar t o that described in long-term survivors of childhood cancer: increased fat mass and reduced lean mass, strength, exercise tolerance, bone mineral dens ity and quality of life. This review considers the possible contribution of GHD to the adverse sequelae observed in long-term survivors of childhood m alignancy and includes our preliminary experience in treating 14 adults wit h GHD resulting from the treatment of childhood malignancies.