Endokrin Sistem Sorunları
Özet
Kanser hastalarında görülen endokrinolojik bozukluklar hem primer maligniteye bağlı olarak hem de uygulanan tedavi modalitelerinin yan etkisi olarak ortaya çıkabilmektedir. Maligniteler, paraneoplastik sendromlar nedeniyle ve tümörlerin doğrudan endokrin organları etkilemesi yoluyla hiperkalsemi, uygunsuz ADH sendromu, ektopik Cushing sendromu ve dirençli hipoglisemi gibi çeşitli endokrinopatilere neden olabilirler. Bunun yanında kemoterapi, immünoterapi, hormonoterapi ve radyoterapi gibi kanser tedavileri de hipotiroidi, hipofizit, adrenal yetmezlik, hipogonadizm ve osteoporoz gibi endokrin bozukluklara yol açabilir.
Hastanın klinik durumunu ve performansını yakından etkileyen bu durumlarda tedavi ve takip sırasında endokrinolojik açıdan dikkatli olunması gerekmekte ve primer hastalık takibi ile birlikte bu durumların takibi de yapılmalıdır. Remisyondaki hastalarda ise endokrinolojik patolojilerin ortaya çıkışı hastalık nüksü açısından önemli bir belirteç olabilir. Bu nedenle özellikle tanı anında endokrin patolojisi olan hastalarda, hormon düzeylerinin takibi gerekmekte ve bu hastaların onkoloji ve endokrinoloji uzmanlarını içeren multidisipliner bir ekip tarafından takip edilmesi gerekmektedir.
Bu bölüm kanser hastalarında görülen tümör ve tedavi ilişkili endokrinolojik sorunları detaylı olarak ele almakta, tedavi ve takip sırasında dikkat edilmesi gereken hususları vurgulamaktadır.
Endocrinological abnormalities in cancer patients may arise from the tumor or as a consequence of the provided therapy modalities. Malignancies can induce numerous endocrinopathies, including hypercalcemia, inappropriate antidiuretic hormone syndrome, ectopic Cushing's syndrome, and refractory hypoglycemia, resulting from paraneoplastic syndromes and tumors directly impacting endocrine organs. Cancer treatments, including chemotherapy, immunotherapy, hormone therapy, and radiotherapy, may induce endocrine abnormalities such as hypothyroidism, hypophysitis, adrenal insufficiency, hypogonadism, and osteoporosis.
In these patients, which significantly impact the patient's clinical condition and performance, endocrinological consideration must be given during therapy and follow-up, and these conditions should be monitored together with the primary disease management. The onset of endocrinological disorders in patients in remission may serve as an important sign of disease relapse. Therefore, especially in patients with endocrine pathology at the time of diagnosis, hormone levels should be monitored and these patients should be followed up by a multidisciplinary team including oncologist and endocrinologist.
This chapter discusses in detail the tumour and treatment-related endocrinological problems seen in cancer patients and emphasises the issues to be considered during treatment and follow-up.
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