Endocrine Abstracts

Introduction: Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy and accounts for 25% of all childhood cancer. With dramatically improved survival rates the long term treatment complications are very important. ALL patients treated with cranial radiotherapy (CRT) and chemotherapy are at increased risk of GH deficiency (GHD), hyperparathyroidism, thyroid cancer and meningiomas.

Method: We present a 45-year-old woman diagnosed with ALL at age 4 years and treated with prophylactic cranial-spinal radiotherapy of 24 Gy and chemotherapy. The patient was diagnosed with GHD at age 32 years. At present she has been treated with GH during 13 years with a median dose of 0.3 mg/day.

Result: She is now menopausal, osteopenic (lumbar spine; Z-score −1.3 S.D.) and femoral neck; Z-score −1.0 S.D.), has primary hyperparathyreoidism, thyroid nodules with papillary microcancer, and on MRI 3 meningeomas and one cavernoma is shown. After surgery of one parathyroid adenoma and thyroidectomy of the left thyroid lobe the postoperative levels of PTH and Calcium returned to normal levels. The findings in CNS will be followed with regularly MRI scans.

Conclusion: This typical ALL case shows the spectrum of possible late complications after treatment for childhood ALL that may involve the entire endocrine system. The latency period is variable and the clinicians must have a high index of suspicion. We estimate that 500 ALL patients are at risk in Sweden (9 million) with the corresponding numbers in other countries.