Endokrine Spätfolgen nach onkologischer Therapie im Kindesalter

Background: As survival rates of childhood cancer have continuously increased over the last few decades, the number of long-term survivors is also steadily growing. Many of these patients are at risk of developing late effects as a consequence of cancer therapy. The occurrence of late effects depends on the treatment regime and may affect different organs. Endocrine late effects are among the most frequent sequelae. Objectives: The present review outlines different endocrine late effects including recommendations for diagnosis and treatment. Results: More than 50% of long-term childhood cancer survivors are affected by endocrine sequelae that mainly occur as a consequence of radiotherapy. They include functional disorders as well as secondary malignancies that have different frequencies and depend on the treatment administered. Especially the thyroid, gonads and the pituitary gland are affected by late effects, although the risk for rare endocrine disorders following cancer treatment is often increased as well. As clinical symptoms of most of these conditions are frequently unspecific, diagnosis relies on laboratory testing that might necessitate dynamic stimulation testing or additional imaging in some cases. Conclusions: Many endocrine late effects of childhood cancer therapy are highly treatable if detected early. National and international guidelines therefore recommend risk-adapted life-long surveillance in specialized late effects clinics.