Long-term endocrine effects of cancer treatment: experience of the Royal Children's Hospital, Melbourne

Prevalence and Risk Factors for Endocrine Disorders in Childhood Brain Tumors From a Single Tertiary Center in Malaysia

Patients with childhood brain tumors are at risk of endocrine disorders. The prevalence of endocrine disorders varies across the world but is unknown in Malaysia. This study's objectives were to determine the prevalence of endocrine disorders among children with brain tumors in Malaysia and to identify endocrinopathy-associated risk factors. We retrospectively reviewed the clinical data of pediatric patients with brain tumors diagnosed and treated at the University Malaya Medical Center from 1 January 2001 to 31 December 2015, with a follow-up period until the age of 18 years old or at least 3 years from the initial diagnosis. A total of 106 patients were included; 71 patients (66%) were screened for endocrine disorders, and 61% of these had endocrine disorders at a median follow-up of 4 years. Hypothyroidism, short stature, and adrenocortical insufficiency were present in one-third of the patients, followed by central diabetes insipidus (21%), growth hormone deficiency (10%), delayed puberty (9%), and precocious puberty (4%). Radiation therapy and surgical intervention were risk factors for endocrine disorders, but hydrocephalus, supratentorial tumors, and malignant tumors were not. Most endocrinopathies developed within the first 2 years of brain tumor diagnosis. Therefore, standard endocrine-monitoring guidelines aiming for early diagnosis and therapy are essential.

Weight management interventions that include dietary components for young people with chronic health care needs: A systematic review

AIMS

To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight.

METHODS

Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively.

RESULTS

The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies.

CONCLUSIONS

There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.

Prevalence of Endocrine Disorders in Childhood Brain Tumor Survivors in South Korea

BACKGROUND/AIM

This longitudinal study aimed to analyze the prevalence of endocrine disorders in childhood brain tumor survivors in South Korea using claims data.

PATIENTS AND METHODS

We identified in 1,058 patients from a nationwide cohort of patients diagnosed with brain tumors between January 1st 2009 to March 29th 2016. Multivariable logistic regression was used to evaluate associations between clinical factors and endocrine disorders.

RESULTS

After a median follow-up of 60.0 months, 393 (37.1%) patients had at least 1 endocrine disorder. The commonest endocrine disorders were hypopituitarism (17.4%) and hypothyroidism (6.1%). Female gender (odds ratio(OR)=1.45, p=0.005) and age <10 years (OR=1.65, p=0.001) conferred a higher risk. Patients who received radiotherapy were more likely to have endocrine disorders compared to those who did not (OR=1.79, p<0.001).

CONCLUSION

Regular assessment of endocrine function and timely interventions are necessary for childhood brain tumor survivors with a risk of endocrine disorders.

Hypothalamic-pituitary function following childhood brain tumors: Analysis of prospective annual endocrine screening

BACKGROUND

Outcomes for childhood brain tumors are now associated with a five-year survival rate of 75%. Endocrine effects of brain tumors are common, occurring in 43% of patients by 10 years from tumor diagnosis. Optimal timing of screening for endocrinopathies remains undefined. We aim to identify incidence and timing of endocrinopathies following brain tumor diagnosis, to better refine screening guidelines.

METHODS

Retrospective chart review of patients referred to our hospital's neuro-oncology clinic for evaluation and treatment of brain tumors. Inclusion criteria were a positive history for brain tumor diagnosis and evaluation at our center. Data collection included demographics, tumor diagnosis, tumor therapy, and endocrinopathy diagnosis and timing. Laboratory data and clinical documentation were reviewed.

RESULTS

Four hundred nineteen subjects were included for analysis. Tumor locations included supratentorial 158 (38%), posterior fossa 145 (35%), suprasellar 96 (23%), and upper spinal cord 20 (5%). Only 61% had undergone endocrine screening. Forty-five percent of screened patients had endocrinopathies. Endocrinopathy diagnosis typically occurred within six years after tumor diagnosis. Tumor recurrence and repeated therapies increased the risk for endocrinopathies within the subsequent six years after tumor therapy. Higher rates of endocrinopathies were identified in patients who had received cranial irradiation for posterior fossa, supratentorial, or suprasellar tumors.

CONCLUSION

Endocrine screening should occur in childhood brain tumor survivors, particularly those who have received irradiation. Our study suggests that in children with brain tumors, the highest yield for finding a pituitary deficiency is within the first six years after tumor diagnosis and treatment. Screening should continue annually beyond six years, but with special attention in the subsequent six years after therapy for tumor recurrence. Prospective screening and endocrinology referral should be implemented in childhood brain tumor survivors.

Hypothalamic Obesity: 4 Years of the International Registry of Hypothalamic Obesity Disorders

OBJECTIVE

Hypothalamic obesity (HyOb) is a rare cause of rapid weight gain and early metabolic comorbidities. Effective treatment strategies are limited. The registry collected participant data and compared treatment approaches.

METHODS

The International Registry of Hypothalamic Obesity Disorders (IRHOD) was created as a registry portal to provide education. Data collected from the initial 4 years were evaluated.

RESULTS

Eighty-seven participants were included for analysis (median age: 27 years, range: 3-71 years). A total of 96.5% had obesity, and 3.5% had overweight at maximal weight. Seventy-five had brain tumors (86%)-the majority were craniopharyngiomas (72% of those with tumors). Nontumor etiologies included congenital brain malformation (4.6%), traumatic brain injury (3.4%), and genetic anomaly (2.3%). Ninety percent received obesity treatments including nutritional counseling (82%), pharmacotherapy (59%), bariatric surgery (8%), and vagal nerve stimulation (1%). Forty-six percent reported follow-up BMI results after obesity treatment. Surgery was most effective (median BMI decrease: -8.2 kg/m2 , median interval: 2.6 years), with lifestyle intervention (BMI: -3.4 kg/m2 , interval: 1.2 years) and pharmacological therapy (BMI: -2.3 kg/m2 , interval: 0.8 years) being less effective. Eighty percent of participants reporting follow-up weight remained in the obesity range.

CONCLUSIONS

IRHOD identified a large cohort with self-reported HyOb. Surgical therapy was most effective at weight reduction. Nutritional counseling and pharmacotherapy modestly improved BMI. Stepwise treatment strategy for HyOb (including nutritional, pharmacological, and surgical therapies in an experienced center) may be most valuable.

Endocrine sequelae of cancer and cancer treatments

INTRODUCTION

Exposure to cancer and its treatments, including chemotherapy and radiotherapy, may result in late adverse effects including endocrine dysfunction. Endocrine disorders are the most commonly reported long-term complications of cancer treatment, especially by adult survivors of childhood cancers. This review will explore the endocrinologic adverse effects from non-endocrine cancer therapies.

METHODS

Searches including various Internet-based medical search engines such as PubMed, Medline Plus, and Google Scholar were conducted for published articles.

RESULTS

One hundred sixty-nine journal articles met the inclusion criteria. They included case reports, systematic analyses, and cohort reports. Endocrine disorders including hypothalamus dysfunction, hypopituitarism, syndrome of inappropriate anti-diuretic hormone secretion, diabetes insipidus, growth hormone disorders, hyperprolactinemia, gonadotropin deficiency, serum thyroid hormone-binding protein abnormalities, hypothyroidism, hyperthyroidism, hypomagnesium, hypocalcemia, hyperparathyroidism, hyperparathyroidism, adrenal dysfunction, gonadal dysfunction, hypertriglyceridemia, hypercholesterolemia, diabetes mellitus, and glycosuria were identified and their association with cancer therapies were outlined.

DISCUSSION/CONCLUSIONS

The journal articles have highlighted the association of cancer therapies, including chemotherapy and radiotherapy, with endocrine dysfunction. Some of the dysfunctions were more often experienced than others. Especially in patients treated with radiotherapy, some endocrinologic disorders were progressive in nature.

IMPLICATIONS FOR CANCER SURVIVORS

Recognition and awareness of endocrine sequelae of cancer treatments may permit for early detection and appropriate follow-up care for cancer survivors, thus improving their overall health and quality of life.

Adverse Late Effects of Childhood Cancer and Its Treatment on Health and Performance

More than 12,000 newly diagnosed cases of cancer occur each year in the United States among children ages 20 years or younger, and the current 5-year survival rate is near 80%. An estimated 228,000 among adults 47 years or younger and currently living in the United States had a diagnosis of cancer during childhood or adolescence. Here, we review long-term adverse effects of childhood cancer and its treatment with an emphasis on physical performance and health. We also briefly review existing guidelines that may be used to develop appropriate exercise and diet interventions for childhood cancer survivors. We suggest that there is a need for development of evidence-based, risk-based guidelines and interventions for health promotion among long-term childhood cancer survivors, particularly for those whose physical activity limitations interfere with chances for optimizing their bodies' potential in today's society.