小児脳腫瘍治療後の内分泌障害とその対応

Endocrine Complications and Their Management Following Treatment of Pediatric Brain Tumors

Point

・小児中枢神経系腫瘍の生存率は著しく改善しているが，生存者は内分泌障害を含む晩期合併症のリスクを抱えている．

・無症状でも障害が進行することがあり，治療後1年，5年，10年，20年を目安に段階的かつ生涯にわたる内分泌評価が必要である．

・小児から成人への移行期医療，生殖医療や生活習慣病対策を含めた包括的管理が求められる．

　Advances in the treatment of pediatric brain tumors have markedly improved survival rates; however, long-term survivors still commonly experience delayed effects, particularly endocrine disorders. Growth hormone deficiency, central hypothyroidism, gonadal dysfunction, including pubertal abnormalities, and central diabetes insipidus are the most common such complications. Their onset is influenced by tumor type, surgical intervention, and cranial irradiation. Survivors of craniopharyngioma commonly develop panhypopituitarism and hypothalamic obesity, whereas survivors of germ cell tumors frequently present with diabetes insipidus and pubertal disturbances. Patients with medulloblastoma, particularly those receiving craniospinal irradiation, are at high risk of growth hormone deficiency and multiple hormonal deficits. These endocrine complications may be progressive and asymptomatic in the early stages, thus underscoring the necessity for systematic follow-up. Lifelong surveillance is recommended, with evaluations conducted at 1, 5, 10, and 20 years after treatment, focusing on growth, puberty, thyroid and adrenal functions, and metabolic status. The transition from pediatric to adult care, fertility preservation, and the management of lifestyle-related diseases represent additional challenges. Comprehensive multidisciplinary follow-up is essential to ensure an optimal quality of life in pediatric brain tumor survivors.