Endocrine sequelae in survivors of childhood cancer

Long-term survival after treatment for childhood cancers has dramatically improved in the past 25 years. Overall 5-year survival rates for childhood cancer are greater than 70%. Residual endocrine disorders are as high as 40% in this population, with the most serious disturbances noted in growth and thyroid function. Dysfunction also is observed in the hypothalamic-pituitary-adrenal axis and the hypothalamic-pituitary-gonadal axis, and recent evidence cites alterations in bone and mineral metabolism, body composition, and lipid disorders. These abnormalities are most likely related directly to prior cancer treatment. This chapter focuses on a description of such disorders and offers suggestions for long-term endocrine management and follow-up evaluation.