Physical Late Effects
Up to 60% childhood cancer survivors will experience at least one hormone-related complication at some point in their life, according to this 2022 study.
Hormonal - or endocrine - late effects can include pituitary disorders, thyroid dysfunction, obesity, diabetes, metabolic syndromes, and decreased bone density. Endocrine late effects are particularly common in survivors who were treated with radiation to the head, neck, or pelvis.
A number of endocrine disorders are caused by an insufficiency of pituitary hormones, which causes hypopituitarism. These disorders include:
Thyroid problems are caused by a deficiency in Thyroid Stimulating Hormone (TSH). The thyroid gland is located in the neck, in front of your windpipe, and it helps regulate your body’s metabolism. Survivors treated with radiation to the head, brain, neck, or spine, or with high doses of MIBG (sometimes used to treat neuroblastoma) are at risk of thyroid problems, and it can take many years after treatment for them to show up.
Central Adrenal Insufficiency is also known as a deficiency of Adrenocorticotropic Hormone (ACTH), which means the adrenal gland isn’t making enough cortisol. Cortisol regulates blood sugar and helps the body deal with physical stress. At-risk survivors (those who received high dose radiation to central area of the brain) should be screened with an annual blood test to check cortisol levels, and a deficiency can be treated by an endocrinologist with hydrocortisone.
Growth Hormone Deficiency is not just a disorder that impacts growing children and teens. The truth is that adults also produce and require small amounts of growth hormone. Beyond your height, growth hormone impacts blood sugar levels, cardiac health, fat stores, and the condition of your muscles and bones. Growth hormone may also play a role in mental health by helping to regulate moods and emotions.
Hormone disorders can also cause low estrogen or testosterone levels, diabetes mellitus, and obesity.
Survivors are at an elevated risk of low and very low bone mineral density, especially those treated with methotrexate, corticosteroids, or hematopoietic stem-cell transplantation. COG guidelines recommend that high-risk survivors receive DEXA scans as part of their long-term follow-up care and ensure adequate calcium and vitamin D intake.