Endocrine complications based on specific tumors and their treatment

Representative tumor, location	Therapy	Highest endocrine risk
Hodgkin lymphoma	Chemotherapy, mantle irradiation	Primary hypothyroidism, primary hypogonadism
Rhabdomyosarcoma or neuroblastoma, pelvis	Excision, chemotherapy, focal radiation	Primary gonadal failure
ALL	Chemotherapy and 18 Gy cranial radiation	Growth hormone deficiency (GHD), early-onset puberty, rapid tempo of puberty, osteoporosis
AML	Chemotherapy to achieve remission, bone marrow transplant (12 Gy total body radiation)	Primary hypothyroidism, primary hypogonadism, reduced epiphyseal growth (direct effect of radiation), GHD, central hypothyroidism
Medulloblastoma, posterior fossa	Surgical excision, chemotherapy, craniospinal irradiation, and posterior fossa "boost" to 50 Gy	Reduced spinal growth, central or primary or mixed hypothyroidism, GHD, precocious puberty and/or gonadotropin deficiency, ACTH deficiency
Craniopharyngioma, suprasellar	Biopsy, excision and focal radiation 30 to 50 Gy	Panhypopituitarism, diabetes insipidus, precocious puberty or gonadotropin deficiency
Rhabdomyosarcoma, nasopharyngeal	Excision, focal radiation 30 to 50 Gy, and chemotherapy	Panhypopituitarism, central or primary or mixed hypothyroidism

ALL: acute lymphoblastic leukemia; AML: acute myeloid leukemia; ACTH: adrenocorticotrophic hormone.

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