Metabolic Risk and Complications in the Treatment of Pediatric and Adolescent Neuroendocrine Neoplasms

In general, endocrine neoplasms—familial or sporadic—are rare among pediatric and adolescent populations. Frequently, the diagnosis is made late due to the indolent nature of such tumors. In the case of hormonal hypersecretion or malignancy, surgical resection is usually the first-line treatment, while, in some cases, radiation and medical treatments are used as adjuvant therapies. In contrast to childhood solid and hematological cancers, data on long-term complications after endocrine neoplasm treatment are limited and mostly based on case series and very small cohorts. Most complications arise from the type of treatment (surgical, radiotherapy, and chemotherapy). In addition to hormonal disturbances affecting growth and puberty, metabolic syndrome with hypothalamic obesity and impaired glucose metabolism are observed among children after treatment for neuroendocrine tumors. The therapeutic options are mainly investigational with limited effectiveness. Recent advances in understanding the pathophysiology of hypothalamic obesity and the metabolic syndrome have allowed for new treatment approaches, both surgical and pharmacological.