Endocrine complications in children with malignancy
Endocrine complications in children with malignancy
Mahboobe Shamloo,1Farnaz Mozayani,2Seyedeh zahra asghar,3Fatemeh babaei,4Abed Ebrahimi,5,*
1. Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran 2. Molecular medicine Research Center, Birjand University of Medical Sciences, Birjand, Iran. 3. Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 4. Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Introduction: Endocrine disorder is caused by dysfunction (increase or decrease) of any of the endocrine glands. These disorders can be primary or secondary in relation to other diseases. One of the secondary endocrine disorders is the development of malignancies.
One of the most important advances in medical science in recent years is the treatment of childhood malignancies, and this increases the life expectancy of these patients to survive. The management of childhood cancer has improved significantly. In the past decade, we have seen great progress not only in conventional treatment but also in the development of targeted therapy with the emergence of new therapies such as immunotherapy and molecular therapies for pediatric cancer. As survival increases, the effects of late cancer treatment have become a major medical issue in childhood cancer survivors.
Most of these survivors experience at least one non-endocrine or endocrine complication. In the meantime, endocrine disorders are the most common complications in childhood cancer survivors, including hematologic malignancies, brain tumors, and sarcomas, and more than 50% of cancer survivors experience at least one hormonal disorder during their lifetime.
Methods: This systematic study was mentioned using key words and referring to reliable scientific databases such as Scopus, PubMed, Google Scholar and ProQuest from the studies that were conducted until 2022 and a total of 16 articles were reviewed.
Results: Strong evidence shows that a large percentage of childhood cancer survivors have endocrine problems and other complications in the prevalence of vision, hearing, cognitive, cardiac, pulmonary, and digestive disorders. Tumors arising near the hypothalamic-pituitary (HP) region and those treated with surgery or radiotherapy involving this region are at risk for HP dysfunction. HP dysfunction means growth hormone deficiency, which leads to impaired linear growth and short stature in adults.
Deficiency and disorder of LH and FSH hormones leads to early central puberty or late puberty, ovarian damage which ultimately leads to a decrease in ovarian reserves, ovarian failure, primary and secondary amenorrhea and early menopause in women, also leads to a decrease in sexual desire and Erectile dysfunction. In males Patients with ACTH deficiency may present with symptoms of adrenal insufficiency, including fatigue, nausea, anorexia, hypoglycemia, poor weight gain, and vulnerability to medical stressors.
Also, the results of studies have shown that thyroid gland abnormalities are one of the most common endocrine complications, which can be seen as hypothyroidism, hyperthyroidism, or toxic thyroid in childhood cancer survivors.
Among other complications after recovery from cancer, we can mention a decrease in bone density and the risk of osteoporosis and fractures caused by it, central diabetes insipidus with symptoms of polydipsia, polyuria and nocturnal enuresis.
Conclusion: As a result, many studies have shown that complications and chronic infectious diseases are observed among cancer survivors, especially recovered children. Several factors, including the length of treatment, age at diagnosis, tumor type, and genetic polymorphisms affect the severity and extent of complications after recovery. In this review, we summarize the current knowledge about endocrine sequelae among CCS and outline facts about lifelong surveillance of these patients, encouraging oncologists and endocrinologists to develop new follow-up guidelines and early detection that Minimize the consequences among these patients.