Results of an endocrinological follow-up of patients with childhood-or adolescent-onset malignancies

BACKGROUND: Established reports about endocrine follow-ups in children and adolescents with cancer were rare. PATIENTS: 53 children were included in the clinical trial. The mean age was 9.6 years (0.5; 17.2 years), 10 patients died within the study period. The mean body length was normal with -0.14 SDS (-2.3; 2.5 SDS), as well as the body weight with 0.01 SDS and BMI with a mean of -0.03 SDS. Children and adolescents with different types of malignant tumors were included. According to the therapy protocol or tumor entity we divided this population in 5 subgroups (group 1 leukemia with 17 patients, group 2 lymphoma with 11 patients, group 3 tumor of CNS with 10 patients, group 4 bone and soft tissue tumors with 8 patients, group 5 different tumors with 7 patients). METHOD: Anthropometrical and laboratory parameters were analyzed in intervals of 6 months over 2 years from the time point of diagnosis. RESULTS: We found differences in body height in children affected by cerebral tumors at the time of diagnosis and therefore before any therapy was started. These patients were significantly shorter (-0.6 SDS) than the other children. The body weight increased within the first year of therapy and was still higher than normal in the second year (comparison at the time point; from start to the first year+0.5 SDS, to second year+0.4 SDS) independently from the cortisone administration. Moreover, significant differences in the growth factor concentrations between the groups and time points were identified. Interestingly, children who survived their malignant disease tended to have higher levels of IGF-I and IGFBP-3 concentration than the patients who died within the study period. Additionally, the thyroid function was affected, shown as an increase of TSH with a concomitant decrease of the free thyroxin in 91% of all patients independent from the diagnosis (start TSH 1.8, fT4 15.6, after first year TSH 2.8, fT4 15.0). Thyroid function was monitored in 12 children, in 5 patients a short- or long-term substitution with thyroid hormone was indicated. Endocrine testing was initiated in 4 children, in 2 patients affection of the adrenal gland could be excluded, a suspected pituitary dysfunction after radiation was confirmed in 2 patients. CONCLUSION: We could represent that children and adolescents with malignant diseases showed affection of the endocrine system due to the tumour and the intensive therapy. The dysregulations in the endocrine system can be diagnosed through closely spaced monitoring and interdisciplinary cooperation.