Long-Term Endocrine and Metabolic Consequences of Cancer Treatment: A Systematic Review

Abstract

The number of patients surviving $5 years after initial cancer diagnosis has significantly increased during the last decades due to considerable improvements in the treatment of many cancer entities. A negative consequence of this is that the emergence of long-term sequelae and endocrine disorders account for a high proportion of these. These late effects can occur decades after cancer treatment and affect up to 50% of childhood cancer survivors. Multiple predisposing factors for endocrine late effects have been identified, including radiation, sex, and age at the time of diagnosis. A systematic literature search has been conducted using the PubMed database to offer a detailed overview of the spectrum of late endocrine disorders following oncological treatment. Most data are based on late effects of treatment in former childhood cancer patients for whom specific guidelines and recommendations already exist, whereas current knowledge concerning late effects in adult-onset cancer survivors is much less clear. Endocrine sequelae of cancer therapy include functional alterations in hypothalamic-pituitary, thyroid, parathyroid, adrenal, and gonadal regulation as well as bone and metabolic complications. Surgery, radiotherapy, chemotherapy, and immunotherapy all contribute to these sequelae. Following irradiation, endocrine organs such as the thyroid are also at risk for subsequent malignancies. Although diagnosis and management of functional and neoplastic long-term consequences of cancer therapy are comparable to other causes of endocrine disorders, cancer survivors need individually structured follow-up care in specialized surveillance centers to improve care for this rapidly growing group of patients.

Evolving pituitary hormone deficits in primarily isolated GHD: a review and experts’ consensus

“…This is even true for children with the dominantly inherited isolated GHD type 2 with splice site mutations of GH1, who may develop additional pituitary hormone deficiencies in rare instances [ 6 ]. Similarly, acquired damage of the hypothalamic-pituitary axis is very likely to proceed from isolated GHD to multiple pituitary hormone deficiency [ 7 ], and in specific damages like the post-radiation condition, prediction is possible based on the dose of radiation [ 8 ]. The severity of isolated GHD may also be a hint to additional hormone deficiencies evolving over time [ 5 ].…”

Continuous treatment with cisplatin induces the oocyte death of primordial follicles without activation

“…The most severely and frequently affected organs by radiation and chemotherapy treatment are endocrine organs such as the hypothalamus, pituitary gland, thyroid gland, ovary, and testes. 1 These complications often appear in childhood cancer survivors (CCSs) months to years after treatment. 2,3 Monitoring complications in CCSs and studying off-target effects of cancer therapy are critical for improving the quality of life.…”

Endokrine Folgen einer Tumortherapie

“…Hyperthyreose mit steigender Dosis zunimmt [18]. Auch niedrige Strahlendosen, denen Patienten im Rahmen einer Stammzelltransplantation ausgesetzt sind, können zu einer Hypothyreose führen [19].…”

“…Internationale Empfehlungen zur Vorsorge bei Risikopatienten unterscheiden sich im Intervall der empfohlenen Kontrollen, wobei die deutsche S3-Leitlinie eine jährliche Kontrolle während der ersten 10 Jahre sowie danach in 2-jährigen Abständen lebenslang vorsieht [17,19].…”