Endocrine Late Effects in Young Cancer Patients: Adrenal Gland

Secondary adrenal insufficiency (SAI) is a rare endocrine late effect of childhood cancer treatment and occurs by injury of the hypothalamic-pituitary (HP) axis due to CNS tumors and surgery, and particularly after cranial radiation. SAI can also occur transiently after unilateral adrenalectomy for adrenal hypercortisolism, or after chronic glucocorticoid therapy. Primary adrenal insufficiency plays no role in childhood cancer survivors and occurs as an acute consequence of cancer treatment (e.g., bilateral adrenalectomy or by inhibition of adrenal steroid biosynthesis). There are many different tests assessing the function of the HP-adrenal axis, but the optimal evaluation for ACTH deficiency is still controversial. The clinical diagnosis of SAI can be challenging due to unspecific symptoms which can develop over a long period. Thus, all childhood cancer survivors should have a regular endocrinology examination of the HPA axis. All physicians involved in the long-term follow-up of childhood cancer survivors must be aware of individuals at risk of developing HPA dysfunction. Implementation of an appropriate treatment together with a detailed instruction regarding stress dose and emergency glucocorticoid administration is necessary to prevent life-threatening adrenal crises in SAI patients.