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DIAGNOSING AND MONITORING ENDOCRINE DYSFUNCTION, DIABETES, AND OBESITY IN A COHORT OF ADULT SURVIVORS OF CHILDHOOD CANCER.

DIAGNOSING AND MONITORING ENDOCRINE DYSFUNCTION, DIABETES, AND OBESITY IN A COHORT OF ADULT SURVIVORS OF CHILDHOOD CANCER.
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Hudspeth VR, Gold SH, Clemmons DR,


Hudspeth VR, Gold SH, Clemmons DR, (click to view)

Hudspeth VR, Gold SH, Clemmons DR,

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Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2017 11 16() doi 10.4158/EP-2017-0033

Abstract
OBJECTIVE
5-year survival for childhood cancer has increased to 80%, resulting in a growing population of adult survivors of childhood cancer (ASOCC). Long-term endocrine dysfunction is as high as 63% when screened in research protocols. The purpose of this study was to evaluate the prevalence of endocrine testing, endocrine dysfunction, diabetes, obesity, and endocrinologist visits outside of a research screening protocol.

METHODS
Retrospective chart review was performed for 176 ASOCC who were diagnosed with cancer before age 18, followed at least 10 years, were now at least 18, and had survived to the time of chart review.

RESULTS
After a mean follow-up of 15.2 years (range 10-21 years), 33.5% of ASOCC had endocrine dysfunction, excluding obesity and diabetes. Prevalence was more common in those with any radiation (p<0.0001) or cranial radiation (p<0.0001), with 64.8% and 73.1% affected respectively. Many subjects had never had certain endocrine tests. 54.6% of subjects were either overweight or obese. A1C testing was rare, but when performed, 38.1% were abnormal. 71% of subjects had never seen an endocrinologist. Even among subjects with cranial radiation, 65.4% had either never seen an endocrinologist or had not seen one in the past 5 years. CONCLUSION
This cohort of ASOCC showed high rates of endocrine dysfunction, overweight or obesity, and diabetes in those who had been tested, combined with low rates of testing and endocrinology evaluation. Endocrinologists need to be aware of the endocrine risks in ASOCC, the need for long-term monitoring, and increase their collaboration with oncology.

ABBREVIATIONS
A1C = Hemoglobin A1C; ACTH = Adrenocorticotropic Hormone; ASOCC = Adult Survivors of Childhood Cancer; BMI = Body Mass Index; COG = Children’s Oncology Group; EMR = Electronic Medical Record; FSH = Follicle Stimulating Hormone; IGF-1 = Insulin-like Growth Factor 1; LH = Luteinizing Hormone; T4 = Thyroxine; TSH = Thyroid Stimulating Hormone.

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