Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Princess Máxima Center for Pediatric Oncology, Department of Neuro-oncology, Utrecht, The Netherlands.
Endocr Rev. 2022 Sep 26;43(5):794-823. doi: 10.1210/endrev/bnab040.
Endocrine disorders in survivors of childhood, adolescent, and young adult (CAYA) cancers are associated with substantial adverse physical and psychosocial effects. To improve appropriate and timely endocrine screening and referral to a specialist, the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) aims to develop evidence and expert consensus-based guidelines for healthcare providers that harmonize recommendations for surveillance of endocrine disorders in CAYA cancer survivors. Existing IGHG surveillance recommendations for premature ovarian insufficiency, gonadotoxicity in males, fertility preservation, and thyroid cancer are summarized. For hypothalamic-pituitary (HP) dysfunction, new surveillance recommendations were formulated by a guideline panel consisting of 42 interdisciplinary international experts. A systematic literature search was performed in MEDLINE (through PubMed) for clinically relevant questions concerning HP dysfunction. Literature was screened for eligibility. Recommendations were formulated by drawing conclusions from quality assessment of all evidence, considering the potential benefits of early detection and appropriate management. Healthcare providers should be aware that CAYA cancer survivors have an increased risk for endocrine disorders, including HP dysfunction. Regular surveillance with clinical history, anthropomorphic measures, physical examination, and laboratory measurements is recommended in at-risk survivors. When endocrine disorders are suspected, healthcare providers should proceed with timely referrals to specialized services. These international evidence-based recommendations for surveillance of endocrine disorders in CAYA cancer survivors inform healthcare providers and highlight the need for long-term endocrine follow-up care in subgroups of survivors and elucidate opportunities for further research.
儿童、青少年和年轻成人（CAYA）癌症幸存者的内分泌疾病与重大的身体和心理社会影响有关。为了改善适当和及时的内分泌筛查，并将患者转介给专家，国际儿童癌症晚期效应指南协调组（IGHG）旨在为医疗保健提供者制定基于证据和专家共识的指南，以协调 CAYA 癌症幸存者内分泌疾病监测的建议。总结了现有的 IGHG 对卵巢早衰、男性性腺毒性、生育力保存和甲状腺癌的监测建议。对于下丘脑-垂体（HP）功能障碍，由 42 名跨学科国际专家组成的指南小组制定了新的监测建议。通过 MEDLINE（通过 PubMed）进行了一项系统的文献检索，以获取有关 HP 功能障碍的临床相关问题。筛选文献以确定其是否符合入选标准。通过对所有证据进行质量评估得出结论，并考虑早期检测和适当管理的潜在益处，制定了建议。医疗保健提供者应该意识到 CAYA 癌症幸存者存在内分泌疾病风险增加的问题，包括 HP 功能障碍。建议对高危幸存者进行常规监测，包括临床病史、人体测量、体格检查和实验室检测。当怀疑存在内分泌疾病时，医疗保健提供者应及时转介至专门的服务机构。这些针对 CAYA 癌症幸存者内分泌疾病监测的国际循证建议为医疗保健提供者提供了信息，并强调了在幸存者亚组中需要进行长期的内分泌随访护理，并阐明了进一步研究的机会。
