Alterations in pubertal timing following therapy for childhood malignancies

The onset of puberty marks a time of rapid linear growth, sexual development, and transition from childhood to maturity. The diagnosis and treatment of a childhood malignancy prior to the onset of puberty has the potential to profoundly affect the timing and the tempo of puberty. CNS tumors located in the hypothalamic-pituitary (H-P) region, surgical resection in this location, and exposure to CNS radiotherapy are all associated with both precocious and delayed puberty. Also, chemotherapy and radiation can directly damage the gonads, which can result in absent, arrested, or delayed puberty. As a consequence of these alterations of pubertal timing, both male and female survivors of childhood cancer may be at risk of adult short-stature, decreased bone-mineral density, absent or incomplete sexual development, and ultimately, reduced rates of fertility. Appropriate and timely assessment of survivors at high risk of alterations in pubertal development will enable the identification of patients who would benefit from early medical intervention.