Chronic endocrinopathies among childhood cancer survivors exposed to radiotherapy

All childhood cancer survivors, <18 years age, who have been exposed to cranial/craniospinal/total body irradiation/ neck /pelvic radiotherapy at least 1 year back will be screened for endocrinopathies, as part of standard of care. Recruitment will take place from the Paediatric Endocrinology Clinic, Department of Paediatrics, Kasturba Medical College, Manipal, and from the Division of Paediatric Hematology and Oncology, Kasturba Medical College, Manipal. Informed consent will be obtained from the parents of the study participants. Assent for older children (12 years and above) will be additionally taken, apart from their parents consent. Details of primary diagnosis, detailed anthropometry, examination will be documented in predesigned proforma. Details of treatment received, chemotherapy regimen, surgery (if underwent), radiation dose, duration, site, and fractions will be documented. GROWTH ASSESSMENT-Height at enrolment will be compared with sex and age matched growth chart and mid parental height. Height velocity <25th centile for age, sex, population (as measured on HV charts by Khadilkar et al) indicative of growth failure. Height < 3rd centile/<2SD – will be considered as short stature. Body segments will be compared to age-appropriate norms. Height velocity will be checked after 6 months. In cases of growth failure or short-stature growth hormone stimulation test will be done. THYROID ASSESSMENT TFT will be done at enrolment and interpreted. ACTH/CORTISOL AXIS At enrolment, 8AM cortisol will be done. If <20 microgram/dl, post ACTH cortisol will be collected. After ACTH stimulation: >20microgram/dl-normal, if <20 microgram/dl hypocortisolism. PUBERTAL ASSESSMENT –Delayed puberty – No thelarche by 13 years/Testicular volume <4ml by 14 years. Whenever delayed puberty is suspected, 8 AM LH/FSH/Testosterone/Estradiol, USG pelvis will be sent and interpreted. Arrested puberty - Among those who are already into puberty, not progressing into subsequent stage of puberty over 6 months. CCS with arrested puberty will be evaluated in a similar line as delayed puberty. Precocious puberty – Thelarche at <8 years/Testicular volume ≥4 ml < 9 years. LH/FSH/Testosterone/Estradiol, USG pelvis will be done and interpreted. In case of obesity(>5 years, BMI >27 adult equivalent centiles, overweight-BMI>23 adult equivalent centiles as per IAP growth charts, <5 years, Overweight - weight/height- +2 to +3SD, Obesity- >+3SD, as per WHO MGRS charts) – Fasting blood sugar, fasting lipid profile, Waist circumference (measured at the mid-point between the subcostal margin and iliac crest), Hip circumference (largest circumference around hips), Waist Hip ratio will be measured, and diagnosis of metabolic syndrome will be made, based on International Obesity Task Force (IOTF) criteria. Metabolic syndrome will be considered if the child has central obesity and meets the criteria for any 2 of the other 4 parameters: Triglycerides, HDL-C, BP, Glucose. Children will be followed up 6 months later to measure their height and ascertain their height velocity.