Emília Kaiserová
Endocrine abnormalities after treatment of CNS tumors arise as direct endocrine organ damage or consequence of hypothalamic- pituitary axis radiation damage. Attenuation of growth is the most common side effect, due to deficiency of growth hormone and hypothyroidism, early puberty and inhibition of vertebral growth by cranial-spinal irradiation as well. Hypothalamic impairment is responsible for obesity. Other factors that induce obesity include reduced physical activity and incorrect lifestyle. Hypothyroidism is a most common abnormality of thyroid gland almost always due to neck radiation for a nonthyroid malignancy. Some survivors may experience hyperthyroidism, thyroid nodules or cancer. Gonadal function is influenced by brain irradiation (hypogonadotrophic hypogonadism) or by chemotherapy, mainly alkylating agents. Development of precocious puberty is a common effect of radiotherapy. Gonadal failure and infertility may be secondary to chemotherapy, in addition to radiotherapy. Main risk factors for renal dysfunction include platinum analogs, ifosfamide and nitrosourea. Drugs with predisposition to cause pulmonary fibrosis include nitrosourea and cyclophosphamide. Functional and cosmetic disabilities involving bone, teeth and soft tissues are common consequence of radiotherapy. Important late effect are second malignancies diagnosed in the period from some month to 25 years after treatment: second leukemia mostly due to chemotherapy and solid tumors predominantly caused by radiotherapy. Cumulative mortality in survivors is 18 % at 25 years from diagnosis. Two thirds of deaths are caused by recurrent disease in interval between 5-9 years after diagnosis.