ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet201533ometendo-7155Research ArticleОбзор литературыReviewМетаболические нарушения у пациентов после комплексного лечения медуллобластомы и острого лимфобластного лейкозаMetabolic disorders in medulloblastoma and acute lymphoblastic leukemia survivorsЦеловальниковаТатьяна ЮрьевнаTseloval'nikovaTat'yana Yur'evna

Врач-эндокринолог клиники эндокринологии УКБ №2

endocrinologist

t.tselovalnikova@gmail.comПавловаМария ГеннадиевнаPavlovaMariya Gennadievna

к.м.н., доцент кафедры эндокринологии лечебного факультета 

Ph.D., assistant professor of endocrinology

mgpavlova68@rambler.ruЗиловАлексей ВадимовичZilovAleksey Vadimovich

к.м.н., доцент кафедры эндокринологии лечебного факультета

Ph.D., assistant professor of endocrinology

avzilov@hotmail.comМазеркинаНадежда АлександровнаMazerkinaNadezhda Aleksandrovna

д.м.н., врач-эндокринолог

Sc.D., endocrinologist

NMazer@nsi.ruЖелудковаОльга ГригорьевнаZheludkovaOl'ga Grigor'evna

д.м.н., профессор, главный научный специалист

Sc.D., prof.,, Chief Scientific Officer

clelud@mail.ruАрефьеваИрина АлексеевнаAref'evaIrina Alekseevna

к.б.н., врач лаборатории клинической биохимии с группой радиоимунных методов исследования

PhD, Laboratory of Clinical Biochemistry with a group of radio immune research methods

IArefyeva@nsi.ruМедведеваОльга АлександровнаMedvedevaOl'ga Aleksandrovna

мл.н.с.

Jr. Researcher

t.tselovalnikova@gmail.comГБОУ ВПО Первый МГМУ им. И.М.Сеченова Минздрава РоссииРоссияI.M. Sechenov’s First Moscow State Medical UniversityRussian FederationГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России, МоскваРоссияI.M. Sechenov’s First Moscow State Medical UniversityRussian FederationНИИ Нейрохирургии им. Н.Н. Бурденко, МоскваРоссияBurdenko Neurosurgical InstituteRussian FederationФГБУ Российский научный центр рентгенорадиологии Минздрава РФРоссияRussian Scientific Center of Roentgeno-RadiologyRussian FederationНИИ нейрохирургии им. Н.Н. Бурденко, МоскваРоссияBurdenko Neurosurgical InstituteRussian Federation20150308201512339Copyright © Целовальникова Т.Ю., Павлова М.Г., Зилов А.В., Мазеркина Н.А., Желудкова О.Г., Арефьева И.А., Медведева О.А., 20152015Целовальникова Т.Ю., Павлова М.Г., Зилов А.В., Мазеркина Н.А., Желудкова О.Г., Арефьева И.А., Медведева О.А.Tseloval'nikova T.Y., Pavlova M.G., Zilov A.V., Mazerkina N.A., Zheludkova O.G., Aref'eva I.A., Medvedeva O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/7155

В течение последних десятилетий наблюдается неуклонный рост онкологической заболеваемости среди детей. Однако наряду с этим, благодаря успехам современных комплексных подходов в противоопухолевой терапии, отмечается и значительное увеличение выживаемости среди данных пациентов. Все больше лиц, перенесших в раннем возрасте ту или иную злокачественную патологию, преодолевают 5-летний барьер выживаемости, формируя группу, нуждающуюся в пожизненном динамическом наблюдении. Ввиду этого сегодня врачи различных специальностей сталкиваются с отдаленными последствиями проведенного комплексного лечения по поводу онкологических заболеваний. Среди различных осложнений следует отдельно выделить метаболические нарушения, как факторы риска развития сердечно-сосудистых заболеваний, которые выступают одной из наиболее частых причин смертности. В статье рассмотрены актуальные представления о различных метаболических изменениях у пациентов после лечения медуллобластомы и острого лимфобластного лейкоза в детстве, механизмах их развития и методах их коррекции.

The childhood cancer morbidity has been steadily increasing over the last few decades. However, the recent more effective complex treatment approaches have led to a dramatic improvements in the survival rate in childhood cancers. Currently many childhood cancer survivors require a life-long follow-up. Therefore, today doctors of various specialties are faced with different long-term consequences after the complex treatment for cancer. Among the various complications metabolic disorders should be eparately identified as risk factors for cardiovascular diseases, which are the most frequent causes of death. This article describes the current understanding of the various metabolic changes in the patients after treatment for medulloblastoma and acute lymphoblastic leukemia in childhood, the mechanisms of their development and treatment issues.

метаболические нарушениядислипидемияожирениемедуллобластомаострый лимфобластный лейкозmetabolic disordersdyslipidemiaobesitymedulloblastomaacute lymphoblastic leukemiaReferencesGlobal Cancer Facts & Figures 2nd Edition. American Cancer Society; 2011. 34-37 p. 2. Ten Leading Causes of Death and Injury [Internet]. Centers for disease control and prevention. 2013. Available from:http://www.cdc.gov/injury/wisqars/LeadingCauses.htmlGlobal Cancer Facts & Figures 2nd Edition. American Cancer Society; 2011. 34-37 p. 2. Ten Leading Causes of Death and Injury [Internet]. Centers for disease control and prevention. 2013. Available from:http://www.cdc.gov/injury/wisqars/LeadingCauses.htmlКаприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2012 году (заболеваемость и смертность). 2014. [Kaprin AD, Starinskii VV, Petrova GV. Zlokachestvennie novoobrazovaniya v Rossii v 2012 gody (zabolevaemost' i smertnost'). 2014. (In Russ).]Каприн А.Д., Старинский В.В., Петрова Г.В. Злокачественные новообразования в России в 2012 году (заболеваемость и смертность). 2014. [Kaprin AD, Starinskii VV, Petrova GV. Zlokachestvennie novoobrazovaniya v Rossii v 2012 gody (zabolevaemost' i smertnost'). 2014. (In Russ).]Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2004 г. // Вестник Российского онкологического научного центра им. Н. Н. Блохина РАМН. – 2006. – Т. 17. – № 3 (прил. 1). –С. 116–132. [Davidov MI, Aksel' EM. Statistika zlokachestvennyh novoobrazovanii v Rossii i stranah SNG v 2004 g. Vestnik Rossiiskogo onkologicheskogo naychnogo centra im. N.N. Blokhina RAMN. 2006;17(3 (pril. 1)):116–32. (In Russ.)].Давыдов М.И., Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2004 г. // Вестник Российского онкологического научного центра им. Н. Н. Блохина РАМН. – 2006. – Т. 17. – № 3 (прил. 1). –С. 116–132. [Davidov MI, Aksel' EM. Statistika zlokachestvennyh novoobrazovanii v Rossii i stranah SNG v 2004 g. Vestnik Rossiiskogo onkologicheskogo naychnogo centra im. N.N. Blokhina RAMN. 2006;17(3 (pril. 1)):116–32. (In Russ.)].Ries LAG, Smith MA, Gurney J, Linet M, Tamra T, Young J, et al. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. 1999.Ries LAG, Smith MA, Gurney J, Linet M, Tamra T, Young J, et al. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. 1999.Hampton T. Cancer treatment's trade-off: years of added life can have long-term costs. JAMA. 2005;294(2):167-8. doi:10.1001/jama.294.2.167Hampton T. Cancer treatment's trade-off: years of added life can have long-term costs. JAMA. 2005;294(2):167-8. doi:10.1001/jama.294.2.167Алиев М.Д., Поляков В.Г., Менткевич Г.Л., Маякова С.А. Детская онкология. Национальное руководство. М.: Издательская группа РОНЦ. Практическая медицина; 2012. 684-5. [Aliev MD, Polyakov VG, Mentkevich GL, Mayakova SA. Detskaya onkologiya. Natcional'noe rykovodstvo. Moscow: Izdatel'skaya gruppa RONC. Prakticheskaya medicina; 2012. 684-5. (In Russ.)].Алиев М.Д., Поляков В.Г., Менткевич Г.Л., Маякова С.А. Детская онкология. Национальное руководство. М.: Издательская группа РОНЦ. Практическая медицина; 2012. 684-5. [Aliev MD, Polyakov VG, Mentkevich GL, Mayakova SA. Detskaya onkologiya. Natcional'noe rykovodstvo. Moscow: Izdatel'skaya gruppa RONC. Prakticheskaya medicina; 2012. 684-5. (In Russ.)].Redaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). European Journal of Cancer Care. 2005;14(1):53-62. doi:10.1111/j.1365-2354.2005.00513.xRedaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). European Journal of Cancer Care. 2005;14(1):53-62. doi:10.1111/j.1365-2354.2005.00513.xDalmasso P, Pastore G, Zuccolo L, Maule MM, Pearce N, Merletti F, et al. Temporal trends in the incidence of childhood leukemia, lymphomas and solid tumors in northwest Italy, 1967-2001. A report of the Childhood Cancer Registry of Piedmont. Haematologica. 2005;90(9):1197-204. PMID:16154843Dalmasso P, Pastore G, Zuccolo L, Maule MM, Pearce N, Merletti F, et al. Temporal trends in the incidence of childhood leukemia, lymphomas and solid tumors in northwest Italy, 1967-2001. A report of the Childhood Cancer Registry of Piedmont. Haematologica. 2005;90(9):1197-204. PMID:16154843Möricke A, Zimmermann M, Reiter A, Henze G, Schrauder A, Gadner H, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia. 2009;24(2):265-84. doi:10.1038/leu.2009.257Möricke A, Zimmermann M, Reiter A, Henze G, Schrauder A, Gadner H, et al. Long-term results of five consecutive trials in childhood acute lymphoblastic leukemia performed by the ALL-BFM study group from 1981 to 2000. Leukemia. 2009;24(2):265-84. doi:10.1038/leu.2009.257Thomas X, Boiron J-M, Huguet F, Dombret H, Bradstock K, Vey N, et al. Outcome of Treatment in Adults With Acute Lymphoblastic Leukemia: Analysis of the LALA-94 Trial. Journal of Clinical Oncology. 2004;22(20):4075-86. doi:10.1200/jco.2004.10.050Thomas X, Boiron J-M, Huguet F, Dombret H, Bradstock K, Vey N, et al. Outcome of Treatment in Adults With Acute Lymphoblastic Leukemia: Analysis of the LALA-94 Trial. Journal of Clinical Oncology. 2004;22(20):4075-86. doi:10.1200/jco.2004.10.050Gökbuget N, Hoelzer D. Treatment of Adult Acute Lymphoblastic Leukemia. Seminars in Hematology. 2009;46(1):64-75. doi:10.1053/j.seminhematol.2008.09.003 13. Румянцева Ю.В., Карачунский А.И., Румянцев А.Г. Оптимизация терапии острого лимфобластного лейкоза у детей в России // Педиатрия. – 2009. – Т. 87, –№ 4. – С. 19–27. [Rymantceva YV, Karachynskii AI, Rymyantcev AG. Optimizatciya terapii ostrogo limfoblastnogo leikoza y detei v Rossii. Pediatriya. 2009;87(4):19–27. (In Russ.)].Gökbuget N, Hoelzer D. Treatment of Adult Acute Lymphoblastic Leukemia. Seminars in Hematology. 2009;46(1):64-75. doi:10.1053/j.seminhematol.2008.09.003 13. Румянцева Ю.В., Карачунский А.И., Румянцев А.Г. Оптимизация терапии острого лимфобластного лейкоза у детей в России // Педиатрия. – 2009. – Т. 87, –№ 4. – С. 19–27. [Rymantceva YV, Karachynskii AI, Rymyantcev AG. Optimizatciya terapii ostrogo limfoblastnogo leikoza y detei v Rossii. Pediatriya. 2009;87(4):19–27. (In Russ.)].Скоробогатова Е.В., Балашов Д.Н., Дышлевая З.М., Трахтман П.Е. Эффективность трансплантации гемопоэтических стволовых клеток (анализ 15-летней работы отделения трансплантации костного мозга РДКБ) // Детская больница. 2008. – Т. 1, – № 31. – С. 27–34. [Skorobogatova EV, Balashov DN, Dyshlevaya ZM, Trakhtman PE. Effektivnost' transplantatcii gemopoeticheskih stvolovyh kletok (analiz 15 letnei raboti otdeleniya transplantatcii kostnogo mozga RDKB). Detskaya bol'nitca. 2008;1(31):27–34. (In Russ.)].Скоробогатова Е.В., Балашов Д.Н., Дышлевая З.М., Трахтман П.Е. Эффективность трансплантации гемопоэтических стволовых клеток (анализ 15-летней работы отделения трансплантации костного мозга РДКБ) // Детская больница. 2008. – Т. 1, – № 31. – С. 27–34. [Skorobogatova EV, Balashov DN, Dyshlevaya ZM, Trakhtman PE. Effektivnost' transplantatcii gemopoeticheskih stvolovyh kletok (analiz 15 letnei raboti otdeleniya transplantatcii kostnogo mozga RDKB). Detskaya bol'nitca. 2008;1(31):27–34. (In Russ.)].Shuster JJ, Falletta JM, Pullen D, Crist W, Humphrey G, Dowell B, et al. Prognostic factors in childhood T-cell acute lymphoblastic leukemia: a Pediatric Oncology Group study. Blood. 1990;75(1):166-73.Shuster JJ, Falletta JM, Pullen D, Crist W, Humphrey G, Dowell B, et al. Prognostic factors in childhood T-cell acute lymphoblastic leukemia: a Pediatric Oncology Group study. Blood. 1990;75(1):166-73.Румянцев А.Г., Самочатова Е.А., Хамдан Табет. Лечение острого лимфобластного лейкоза у детей по программе BFM // Педиатрия. – 1991. – № 11. – С. 58–63. [Rymyantcev AG, Samochatova EA, Khamdan Tabet. Lechenie ostrogo limfoblastnogo leikoza y detei po programme BFM. Pediatriya. 1991;(11):58–63.) In. Russ.)].Румянцев А.Г., Самочатова Е.А., Хамдан Табет. Лечение острого лимфобластного лейкоза у детей по программе BFM // Педиатрия. – 1991. – № 11. – С. 58–63. [Rymyantcev AG, Samochatova EA, Khamdan Tabet. Lechenie ostrogo limfoblastnogo leikoza y detei po programme BFM. Pediatriya. 1991;(11):58–63.) In. Russ.)].Румянцев А.Г., Владимирская Е.Б. Перспективы развития детской гематологии/ онкологии в России // Педиатрия. – 1995. – № 2. – С. 5–9. [Rymyantcev AG, Vladimirskaya EB. Perspektivy razvitiya detskoi gematologii v Rossii. Pediatriya. 1995;(2):5–9. (In Russ.)].Румянцев А.Г., Владимирская Е.Б. Перспективы развития детской гематологии/ онкологии в России // Педиатрия. – 1995. – № 2. – С. 5–9. [Rymyantcev AG, Vladimirskaya EB. Perspektivy razvitiya detskoi gematologii v Rossii. Pediatriya. 1995;(2):5–9. (In Russ.)].Baldwin RT, Preston-Martin S. Epidemiology of brain tumors in childhood— a review. Toxicology and Applied Pharmacology. 2004;199(2):118-31. doi:10.1016/j.taap.2003.12.029Baldwin RT, Preston-Martin S. Epidemiology of brain tumors in childhood— a review. Toxicology and Applied Pharmacology. 2004;199(2):118-31. doi:10.1016/j.taap.2003.12.029Белогурова М.Б. Детская онкология: руководство для врачей. СПб: СпецЛит; 2002. [Belogyrova MB. Detsskaya onkologiya: rykovodstvo dlya vrachei. Saint Petersburg: SpetcLit; 2002. (In Russ.)].Белогурова М.Б. Детская онкология: руководство для врачей. СПб: СпецЛит; 2002. [Belogyrova MB. Detsskaya onkologiya: rykovodstvo dlya vrachei. Saint Petersburg: SpetcLit; 2002. (In Russ.)].Желудкова О.Г. Лечение опухолей головного мозга у детей // Врач. – 2011. – № 12. – С. 22–27. [Zheludkova OG. Lechenie opyholei golovnogo mozga y detei. Vrach. 2011;(12):22–7. (In Russ.)].Желудкова О.Г. Лечение опухолей головного мозга у детей // Врач. – 2011. – № 12. – С. 22–27. [Zheludkova OG. Lechenie opyholei golovnogo mozga y detei. Vrach. 2011;(12):22–7. (In Russ.)].Айкарди Ж. Заболевания нервной системы у детей: в 2-х т. М.: Издательство Панфилова; БИНОМ. Лаборатория знаний, 2013. [Aikardi G. Zabolevaniya nervnoi sistemy y detei: v 2-h t. Moscow.: Izdatel'stvo Panfilova; BINOM. Laboratoriya znanii; 2013; 557–85. (In Russ.)].Айкарди Ж. Заболевания нервной системы у детей: в 2-х т. М.: Издательство Панфилова; БИНОМ. Лаборатория знаний, 2013. [Aikardi G. Zabolevaniya nervnoi sistemy y detei: v 2-h t. Moscow.: Izdatel'stvo Panfilova; BINOM. Laboratoriya znanii; 2013; 557–85. (In Russ.)].Gottardo NG, Hansford JR, McGlade JP, Alvaro F, Ashley DM, Bailey S, et al. Medulloblastoma Down Under 2013: a report from the third annual meeting of the International Medulloblastoma Working Group. Acta Neuropathologica. 2013;127(2):189-201. doi:10.1007/s00401-013-1213-7Gottardo NG, Hansford JR, McGlade JP, Alvaro F, Ashley DM, Bailey S, et al. Medulloblastoma Down Under 2013: a report from the third annual meeting of the International Medulloblastoma Working Group. Acta Neuropathologica. 2013;127(2):189-201. doi:10.1007/s00401-013-1213-7Шонус Д.Х., Щербенко ИО. Медуллобластома у детей. Клиника, диагностика, лечение, нерешенные проблемы. [Internet]. Вестник РНЦР. 2013. Available from: http://vestnik.rncrr.ru/vestnik/v13/papers/shonus_v13.htmШонус Д.Х., Щербенко ИО. Медуллобластома у детей. Клиника, диагностика, лечение, нерешенные проблемы. [Internet]. Вестник РНЦР. 2013. Available from: http://vestnik.rncrr.ru/vestnik/v13/papers/shonus_v13.htmЖелудкова О.Г., Бухны А.Ф., Холодов Б.В., Притыко А.Г., Лившиц М.И., Попов В.Е. и др. Полихимиотерапия в комплексном лечении медуллобластом у детей // Материалы второй ежегодной Российской конференции «Современные тенденции развития лекарственной терапии опухолей». Москва, 1998. С. 73–75. [Zheludkova OG, Bykhni AF, Kholodov BV, Prityko AG, Livshitc MI, Popov VE et al. Polykhimioterapiya v kompleksnom lechenii medulloblastom y detei. Materiali vtoroi ezhegodnoi Rossiiskoi konferentcii "Sovremennye tendentcii razvitiya lekarstvennoi terapii opyholei". Moscow; 1998; 73–5 (In Russ.)].Желудкова О.Г., Бухны А.Ф., Холодов Б.В., Притыко А.Г., Лившиц М.И., Попов В.Е. и др. Полихимиотерапия в комплексном лечении медуллобластом у детей // Материалы второй ежегодной Российской конференции «Современные тенденции развития лекарственной терапии опухолей». Москва, 1998. С. 73–75. [Zheludkova OG, Bykhni AF, Kholodov BV, Prityko AG, Livshitc MI, Popov VE et al. Polykhimioterapiya v kompleksnom lechenii medulloblastom y detei. Materiali vtoroi ezhegodnoi Rossiiskoi konferentcii "Sovremennye tendentcii razvitiya lekarstvennoi terapii opyholei". Moscow; 1998; 73–5 (In Russ.)].Meadows AT. Pediatric cancer survivors: past history and future challenges. Current Problems in Cancer. 2003;27(3):112-26. doi:10.1016/s0147-0272(03)00025-4Meadows AT. Pediatric cancer survivors: past history and future challenges. Current Problems in Cancer. 2003;27(3):112-26. doi:10.1016/s0147-0272(03)00025-4Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic Health Conditions in Adult Survivors of Childhood Cancer. New England Journal of Medicine. 2006;355(15):1572-82. doi:10.1056/NEJMsa060185Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic Health Conditions in Adult Survivors of Childhood Cancer. New England Journal of Medicine. 2006;355(15):1572-82. doi:10.1056/NEJMsa060185Hawkins MM, Kingston JE, Kinnier Wilson LM. Late deaths after treatment for childhood cancer. Archives of Disease in Childhood. 1990;65(12):1356-63. doi:10.1136/adc.65.12.1356Hawkins MM, Kingston JE, Kinnier Wilson LM. Late deaths after treatment for childhood cancer. Archives of Disease in Childhood. 1990;65(12):1356-63. doi:10.1136/adc.65.12.1356Talvensaari KK. Long-term survivors of childhood cancer have an increased risk of manifesting the metabolic syndrome. Journal of Clinical Endocrinology & Metabolism. 1996;81(8):3051-5. doi:10.1210/jc.81.8.3051Talvensaari KK. Long-term survivors of childhood cancer have an increased risk of manifesting the metabolic syndrome. Journal of Clinical Endocrinology & Metabolism. 1996;81(8):3051-5. doi:10.1210/jc.81.8.3051Мазеркина Н.А. Эндокринные последствия лечения злокачественных опухолей мозга у детей // Cons. Medicum. – 2012. – Т. 14, – № 12. – С. 92–97. [Mazerkina NA. Endocrinnye posledstviya zlokachestvennyh opyholei mozga y detei. Cons Medicum. 2012;14(12):92–7. (In Russ.)].Мазеркина Н.А. Эндокринные последствия лечения злокачественных опухолей мозга у детей // Cons. Medicum. – 2012. – Т. 14, – № 12. – С. 92–97. [Mazerkina NA. Endocrinnye posledstviya zlokachestvennyh opyholei mozga y detei. Cons Medicum. 2012;14(12):92–7. (In Russ.)].Withycombe JS, Post-White JE, Meza JL, Hawks RG, Smith LM, Sacks N, et al. Weight patterns in children with higher risk ALL: A report from the Children's Oncology Group (COG) for CCG 1961. Pediatric Blood & Cancer. 2009;53(7):1249-54. doi:10.1002/pbc.22237Withycombe JS, Post-White JE, Meza JL, Hawks RG, Smith LM, Sacks N, et al. Weight patterns in children with higher risk ALL: A report from the Children's Oncology Group (COG) for CCG 1961. Pediatric Blood & Cancer. 2009;53(7):1249-54. doi:10.1002/pbc.22237Dengel DR, Ness KK, Glasser SP, Williamson EB, Baker KS, Gurney JG. Endothelial Function in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Pediatric Hematology/Oncology. 2008;30(1):20-5. doi:10.1097/MPH.0b013e318159a593Dengel DR, Ness KK, Glasser SP, Williamson EB, Baker KS, Gurney JG. Endothelial Function in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Pediatric Hematology/Oncology. 2008;30(1):20-5. doi:10.1097/MPH.0b013e318159a593Lustig RH, Post SR, Srivannaboon K, Rose SR, Danish RK, Burghen GA, et al. Risk Factors for the Development of Obesity in Children Surviving Brain Tumors. The Journal of Clinical Endocrinology & Metabolism. 2003;88(2):611-6. doi:10.1210/jc.2002-021180Lustig RH, Post SR, Srivannaboon K, Rose SR, Danish RK, Burghen GA, et al. Risk Factors for the Development of Obesity in Children Surviving Brain Tumors. The Journal of Clinical Endocrinology & Metabolism. 2003;88(2):611-6. doi:10.1210/jc.2002-021180Oeffinger KC. Obesity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology. 2003;21(7):1359-65. doi:10.1200/jco.2003.06.131Oeffinger KC. Obesity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology. 2003;21(7):1359-65. doi:10.1200/jco.2003.06.131Heikens J, Ubbink MC, van der Pal HPJ, Bakker PJM, Fliers E, Smilde TJ, et al. Long term survivors of childhood brain cancer have an increased risk for cardiovascular disease. Cancer. 2000;88(9):2116-21. doi:10.1002/(sici)1097-0142(20000501)88:9<2116::aid-cncr18>3.0.co;2-uHeikens J, Ubbink MC, van der Pal HPJ, Bakker PJM, Fliers E, Smilde TJ, et al. Long term survivors of childhood brain cancer have an increased risk for cardiovascular disease. Cancer. 2000;88(9):2116-21. doi:10.1002/(sici)1097-0142(20000501)88:9<2116::aid-cncr18>3.0.co;2-uPietilä S, Mäkipernaa A, Sievänen H, Koivisto AM, Wigren T, Lenko HL. Obesity and metabolic changes are common in young childhood brain tumor survivors. Pediatric blood & cancer. 2009;52(7):853-9.Pietilä S, Mäkipernaa A, Sievänen H, Koivisto AM, Wigren T, Lenko HL. Obesity and metabolic changes are common in young childhood brain tumor survivors. Pediatric blood & cancer. 2009;52(7):853-9.Siviero-Miachon AA, Monteiro CMdC, Pires LV, Rozalem AC, Silva NSd, Petrilli AS, et al. Early traits of metabolic syndrome in pediatric post-cancer survivors: outcomes in adolescents and young adults treated for childhood medulloblastoma. Arquivos Brasileiros de Endocrinologia & Metabologia. 2011;55(8):653-60. doi:10.1590/s0004-27302011000800022Siviero-Miachon AA, Monteiro CMdC, Pires LV, Rozalem AC, Silva NSd, Petrilli AS, et al. Early traits of metabolic syndrome in pediatric post-cancer survivors: outcomes in adolescents and young adults treated for childhood medulloblastoma. Arquivos Brasileiros de Endocrinologia & Metabologia. 2011;55(8):653-60. doi:10.1590/s0004-27302011000800022Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors. Cancer. 2003;97(3):663-73. doi:10.1002/cncr.11095Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors. Cancer. 2003;97(3):663-73. doi:10.1002/cncr.11095Gurney JG, Ness KK, Stovall M, Wolden S, Punyko JA, Neglia JP, et al. Final Height and Body Mass Index among Adult Survivors of Childhood Brain Cancer: Childhood Cancer Survivor Study. The Journal of Clinical Endocrinology & Metabolism. 2003;88(10):4731-9. doi:10.1210/jc.2003-030784Gurney JG, Ness KK, Stovall M, Wolden S, Punyko JA, Neglia JP, et al. Final Height and Body Mass Index among Adult Survivors of Childhood Brain Cancer: Childhood Cancer Survivor Study. The Journal of Clinical Endocrinology & Metabolism. 2003;88(10):4731-9. doi:10.1210/jc.2003-030784Esbenshade AJ, Simmons JH, Koyama T, Koehler E, Whitlock JA, Friedman DL. Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia. Pediatric Blood & Cancer. 2011;56(3):372-8. doi:10.1002/pbc.22782Esbenshade AJ, Simmons JH, Koyama T, Koehler E, Whitlock JA, Friedman DL. Body mass index and blood pressure changes over the course of treatment of pediatric acute lymphoblastic leukemia. Pediatric Blood & Cancer. 2011;56(3):372-8. doi:10.1002/pbc.22782Iughetti L, Bruzzi P, Predieri B, Paolucci P. Obesity in patients with acute lymphoblastic leukemia in childhood. Italian Journal of Pediatrics. 2012;38(1):4. doi:10.1186/1824-7288-38-4Iughetti L, Bruzzi P, Predieri B, Paolucci P. Obesity in patients with acute lymphoblastic leukemia in childhood. Italian Journal of Pediatrics. 2012;38(1):4. doi:10.1186/1824-7288-38-4Baillargeon J, Langevin A-M, Lewis M, Grady JJ, Thomas PJ, Mullins J, et al. Therapy-related changes in body size in Hispanic children with acute lymphoblastic leukemia. Cancer. 2005;103(8):1725-9. doi:10.1002/cncr.20948Baillargeon J, Langevin A-M, Lewis M, Grady JJ, Thomas PJ, Mullins J, et al. Therapy-related changes in body size in Hispanic children with acute lymphoblastic leukemia. Cancer. 2005;103(8):1725-9. doi:10.1002/cncr.20948Rogers PC, Meacham LR, Oeffinger KC, Henry DW, Lange BJ. Obesity in pediatric oncology. Pediatric Blood & Cancer. 2005;45(7):881-91. doi:10.1002/pbc.20451Rogers PC, Meacham LR, Oeffinger KC, Henry DW, Lange BJ. Obesity in pediatric oncology. Pediatric Blood & Cancer. 2005;45(7):881-91. doi:10.1002/pbc.20451Gurney JG, Ness KK, Sibley SD, O'Leary M, Dengel DR, Lee JM, et al. Metabolic syndrome and growth hormone deficiency in adult survivors of childhood acute lymphoblastic leukemia. Cancer. 2006;107(6):1303-12. doi:10.1002/cncr.22120Gurney JG, Ness KK, Sibley SD, O'Leary M, Dengel DR, Lee JM, et al. Metabolic syndrome and growth hormone deficiency in adult survivors of childhood acute lymphoblastic leukemia. Cancer. 2006;107(6):1303-12. doi:10.1002/cncr.22120Oeffinger KC, Buchanan GR, Eshelman DA, Denke MA, Andrews TC, Germak JA, et al. Cardiovascular Risk Factors in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Pediatric Hematology/Oncology. 2001;23(7):424-30. doi:10.1097/00043426-200110000-00007Oeffinger KC, Buchanan GR, Eshelman DA, Denke MA, Andrews TC, Germak JA, et al. Cardiovascular Risk Factors in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Pediatric Hematology/Oncology. 2001;23(7):424-30. doi:10.1097/00043426-200110000-00007Craig F, Leiper AD, Stanhope R, Brain C, Meller ST, Nussey SS. Sexually dimorphic and radiation dose dependent effect of cranial irradiation on body mass index. Archives of Disease in Childhood. 1999;81(6):500-4. doi:10.1136/adc.81.6.500Craig F, Leiper AD, Stanhope R, Brain C, Meller ST, Nussey SS. Sexually dimorphic and radiation dose dependent effect of cranial irradiation on body mass index. Archives of Disease in Childhood. 1999;81(6):500-4. doi:10.1136/adc.81.6.500Sklar CA, Mertens AC, Walter A, Mitchell D, Nesbit ME, O'Leary M, et al. Changes in body mass index and prevalence of overweight in survivors of childhood acute lymphoblastic leukemia: Role of cranial irradiation. Medical and Pediatric Oncology. 2000;35(2):91-5. doi:10.1002/1096-911x(200008)35:2<91::aid-mpo1>3.0.co;2-gSklar CA, Mertens AC, Walter A, Mitchell D, Nesbit ME, O'Leary M, et al. Changes in body mass index and prevalence of overweight in survivors of childhood acute lymphoblastic leukemia: Role of cranial irradiation. Medical and Pediatric Oncology. 2000;35(2):91-5. doi:10.1002/1096-911x(200008)35:2<91::aid-mpo1>3.0.co;2-gSiviero-Miachon AA, Spinola-Castro AM, Guerra-Junior G. Adiposity in childhood cancer survivors: insights into obesity physiopathology. Arquivos Brasileiros de Endocrinologia & Metabologia. 2009;53(2). doi:10.1590/s0004-27302009000200011Siviero-Miachon AA, Spinola-Castro AM, Guerra-Junior G. Adiposity in childhood cancer survivors: insights into obesity physiopathology. Arquivos Brasileiros de Endocrinologia & Metabologia. 2009;53(2). doi:10.1590/s0004-27302009000200011Link K, Moëll C, Garwicz S, Cavallin-Ståhl E, Björk J, Thilén U, et al. Growth Hormone Deficiency Predicts Cardiovascular Risk in Young Adults Treated for Acute Lymphoblastic Leukemia in Childhood. The Journal of Clinical Endocrinology & Metabolism. 2004;89(10):5003-12. doi:10.1210/jc.2004-0126Link K, Moëll C, Garwicz S, Cavallin-Ståhl E, Björk J, Thilén U, et al. Growth Hormone Deficiency Predicts Cardiovascular Risk in Young Adults Treated for Acute Lymphoblastic Leukemia in Childhood. The Journal of Clinical Endocrinology & Metabolism. 2004;89(10):5003-12. doi:10.1210/jc.2004-0126Bulow B, Link K, Ahren B, Nilsson A-S, Erfurth EM. Survivors of childhood acute lymphoblastic leukaemia, with radiation-induced GH deficiency, exhibit hyperleptinaemia and impaired insulin sensitivity, unaffected by 12 months of GH treatment. Clinical Endocrinology. 2004;61(6):683-91. doi:10.1111/j.1365-2265.2004.02149.xBulow B, Link K, Ahren B, Nilsson A-S, Erfurth EM. Survivors of childhood acute lymphoblastic leukaemia, with radiation-induced GH deficiency, exhibit hyperleptinaemia and impaired insulin sensitivity, unaffected by 12 months of GH treatment. Clinical Endocrinology. 2004;61(6):683-91. doi:10.1111/j.1365-2265.2004.02149.xJarfelt M, Lannering B, Bosaeus I, Johannsson G, Bjarnason R. Body composition in young adult survivors of childhood acute lymphoblastic leukaemia. European Journal of Endocrinology. 2005;153(1):81-9. doi:10.1530/eje.1.01931Jarfelt M, Lannering B, Bosaeus I, Johannsson G, Bjarnason R. Body composition in young adult survivors of childhood acute lymphoblastic leukaemia. European Journal of Endocrinology. 2005;153(1):81-9. doi:10.1530/eje.1.01931Trimis G, Moschovi M, Papassotiriou I, Chrousos G, Tzortzatou-Stathopoulou F. Early Indicators of Dysmetabolic Syndrome in Young Survivors of Acute Lymphoblastic Leukemia in Childhood as a Target for Preventing Disease. Journal of Pediatric Hematology/Oncology. 2007;29(5):309-14. doi:10.1097/MPH.0b013e318059c249Trimis G, Moschovi M, Papassotiriou I, Chrousos G, Tzortzatou-Stathopoulou F. Early Indicators of Dysmetabolic Syndrome in Young Survivors of Acute Lymphoblastic Leukemia in Childhood as a Target for Preventing Disease. Journal of Pediatric Hematology/Oncology. 2007;29(5):309-14. doi:10.1097/MPH.0b013e318059c249Birkebak NH, Clausen N. Height and weight pattern up to 20 years after treatment for acute lymphoblastic leukaemia. Archives of Disease in Childhood. 1998;79(2):161-4. doi:10.1136/adc.79.2.161Birkebak NH, Clausen N. Height and weight pattern up to 20 years after treatment for acute lymphoblastic leukaemia. Archives of Disease in Childhood. 1998;79(2):161-4. doi:10.1136/adc.79.2.161Oeffinger KC, Adams-Huet B, Victor RG, Church TS, Snell PG, Dunn AL, et al. Insulin Resistance and Risk Factors for Cardiovascular Disease in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Clinical Oncology. 2009;27(22):3698-704. doi:10.1200/jco.2008.19.7251Oeffinger KC, Adams-Huet B, Victor RG, Church TS, Snell PG, Dunn AL, et al. Insulin Resistance and Risk Factors for Cardiovascular Disease in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia. Journal of Clinical Oncology. 2009;27(22):3698-704. doi:10.1200/jco.2008.19.7251Kavey REW, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics. Circulation. 2006;114(24):2710- 38. doi:10.1161/circulationaha.106.1795Kavey REW, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, et al. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics. Circulation. 2006;114(24):2710- 38. doi:10.1161/circulationaha.106.1795

The authors declare that there are no conflicts of interest present.