Complicaciones endocrinas precoces en supervivientes de neoplasias infantiles / Early endocrine complications in childhood cancer survivors

Fundamento y objetivos: El tratamiento de las neoplasias infantiles ha aumentado las tasas de supervivencia, pero también el riesgo de desarrollar complicaciones tardías, muchas de tipo endocrino. El objetivo de este estudio es describir las endocrinopatías que se presentan en los primeros años de seguimiento de las neoplasias infantiles y analizar las variables relacionadas con su aparición. Sujetos y métodos: Estudio retrospectivo de los pacientes remitidos a Endocrinología Pediátrica tras el tratamiento de una neoplasia maligna. Como endocrinopatías se incluyeron las afecciones hormonales por exceso o por defecto y la obesidad de nueva aparición. Las evaluaciones clínicas y analíticas se realizaron semestralmente. Pruebas estadísticas: chi cuadrado y regresión logística múltiple. Resultados: Se incluyen 55 pacientes (26 mujeres) con una edad en el momento del diagnóstico del tumor (media±desviación estándar) de 6,0±4,4 años y un seguimiento de 6,8±3,6 años. Se diagnosticaron 30 endocrinopatías en 26 pacientes (47,3%), de los que 17 eran mujeres (p=0,01). Once adolescentes presentaron hipogonadismo primario (26,2%, a los 0,6±0,5 años de seguimiento), relacionándose su aparición con la radioterapia pélvica (odds ratio ajustada [OR] 3,99, p=0,005). Once pacientes presentaron algún trastorno hipofisario (20,0%, a los 5,2±2,4 años tras el diagnóstico) en relación con radioterapia cerebral (OR 1,54, p=0,039). Seis niños (10,9%) presentaron hipotiroidismo primario a los 3,2±1,0 años de seguimiento. Dos niños desarrollaron obesidad. Conclusiones: Los niños supervivientes de neoplasias malignas presentan diversas endocrinopatías ya en los primeros años tras el tratamiento oncológico, por lo que la evaluación hormonal debe iniciarse precozmente y repetirse de forma periódica (AU)

Background and objectives: The treatment of childhood cancers has increased survival rates, but also the risk of sequelae, such as endocrine complications. The objective of this study is to evaluate the endocrine disorders in survivors of childhood malignant tumors within the first years after treatment and analyze the variables related to their appearance. Subjects and methods: A retrospective medical record review of patients referred to pediatric endocrinology after treatment of malignancy. Outcome measures were frequency and types of endocrine dysfunction and new-onset obesity. Clinical and laboratory evaluations were performed every 6 months. Statistics tests were: chi square and multiple logistic regression. Results: Fifty five patients (26 women) were included with an age at diagnosis of tumour (mean±standard deviation) 6.0±4.4 years and followed up for 6.8±3.6 years. Thirty endocrine disorders were diagnosed in 26 patients (47.3%), 17 women (P=.01). Eleven adolescents had primary hypogonadism (26.2% to 0.6±0.5 years of follow-up) in relation to local irradiation (adjusted odds ratio [OR] 3.99, P=.005). Eleven patients had a pituitary disorder (20.0%) 5.2±2.4 years after diagnosis in relation to brain irradiation (OR 1.54, P=.039). Six children (10.9%) had primary hypothyroidism from 3.2±1.0 years of follow-up. Two children developed obesity. Conclusions: Endocrine disorders are frequently seen within the first years after diagnosis of a childhood cancer, so hormonal evaluation should start early and be repeated periodically (AU)

[Early endocrine complications in childhood cancer survivors]. / Complicaciones endocrinas precoces en supervivientes de neoplasias infantiles.

BACKGROUND AND OBJECTIVES: The treatment of childhood cancers has increased survival rates, but also the risk of sequelae, such as endocrine complications. The objective of this study is to evaluate the endocrine disorders in survivors of childhood malignant tumors within the first years after treatment and analyze the variables related to their appearance. SUBJECTS AND METHODS: A retrospective medical record review of patients referred to pediatric endocrinology after treatment of malignancy. Outcome measures were frequency and types of endocrine dysfunction and new-onset obesity. Clinical and laboratory evaluations were performed every 6 months. Statistics tests were: chi square and multiple logistic regression. RESULTS: Fifty five patients (26 women) were included with an age at diagnosis of tumour (mean±standard deviation) 6.0±4.4 years and followed up for 6.8±3.6 years. Thirty endocrine disorders were diagnosed in 26 patients (47.3%), 17 women (P=.01). Eleven adolescents had primary hypogonadism (26.2% to 0.6±0.5 years of follow-up) in relation to local irradiation (adjusted odds ratio [OR] 3.99, P=.005). Eleven patients had a pituitary disorder (20.0%) 5.2±2.4 years after diagnosis in relation to brain irradiation (OR 1.54, P=.039). Six children (10.9%) had primary hypothyroidism from 3.2±1.0 years of follow-up. Two children developed obesity. CONCLUSIONS: Endocrine disorders are frequently seen within the first years after diagnosis of a childhood cancer, so hormonal evaluation should start early and be repeated periodically.