Sánchez González Cristina, Andrades Toledo Mónica, Cárdeno Morales Álvaro, Gutiérrez Carrasco Ignacio, Ramírez Villar Gema Lucía, Pérez Hurtado José María, García García Emilio
Unidad de Pediatría, Hospital Virgen del Rocío, Sevilla, España.
Unidad de Oncología Pediátrica, Hospital Virgen del Rocío, Sevilla, España.
Med Clin (Barc). 2016 Oct 21;147(8):329-333. doi: 10.1016/j.medcli.2016.06.005. Epub 2016 Jul 20.
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.
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.
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.
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.
儿童癌症治疗提高了生存率，但也增加了后遗症风险，如内分泌并发症。本研究的目的是评估儿童恶性肿瘤幸存者在治疗后的头几年内的内分泌紊乱情况，并分析与其出现相关的变量。
对恶性肿瘤治疗后转诊至儿科内分泌科的患者进行回顾性病历审查。观察指标为内分泌功能障碍的频率和类型以及新发肥胖情况。每6个月进行一次临床和实验室评估。统计学检验采用卡方检验和多元逻辑回归。
纳入55例患者（26例女性），肿瘤诊断时年龄（均值±标准差）为6.0±4.4岁，随访6.8±3.6年。26例患者（47.3%）诊断出30种内分泌紊乱，其中17例为女性（P = 0.01）。11例青少年因局部放疗出现原发性性腺功能减退（26.2%，随访0.6±0.5年）（调整比值比[OR] 3.99，P = 0.005）。11例患者在诊断后5.2±2.4年因脑部放疗出现垂体疾病（20.0%）（OR 1.54，P = 0.039）。6例儿童（10.9%）在随访3.2±1.0年后出现原发性甲状腺功能减退。2例儿童出现肥胖。
儿童癌症诊断后的头几年内经常出现内分泌紊乱，因此激素评估应尽早开始并定期重复进行。
