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Endocrine effects of other diseases and treatments 

Endocrine effects of other diseases and treatments
Chapter:
Endocrine effects of other diseases and treatments
Author(s):

Gary Butler

and Jeremy Kirk

DOI:
10.1093/med/9780198786337.003.0004
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date: 18 June 2021

Survival rates for childhood cancer have doubled over the last 50 years.

With improved numbers of survivors of childhood cancer (currently 1 in 715 young adults), late effects (including endocrine) of therapy are increasingly recognized.

Endocrine late effects are found in 20–50% of patients (multiple in up to 20%) dependent on underlying malignancy, age, sex, and time elapsed since therapy.

In addition to the tumour itself, the three main treatment modalities—surgery, radiotherapy, and chemotherapy—all cause late effects.

Radiotherapy can be used either on its own, or following chemotherapy and/or surgery. It produces late effects via action on the:

pituitary/hypothalamus

endocrine gland itself

end organ such as bone.

Effects are dependent on site, total dose, and also regimen, e.g. single dose vs fractionated. They are also progressive and irreversible.

Chemotherapy:

generally produces gonadal toxicity; with little effect on other endocrine glands (including pituitary/hypothalamus). Osteopenia/osteoporosis and dyslipidaemia are also described

damage dependent on type and dose, plus age at administration

effects may be reversible.

Poor growth following cancer therapy is multifactorial:

non-hormonal: poor nutrition, steroid therapy, direct bone/soft tissue damage

hormonal: GH deficiency, delayed/premature puberty, hypothyroidism

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