Endocrine consequences of cranial irradiation in children: Mechanisms, impacts, and sex differences.

Cranial irradiation is a vital adjunctive therapy for pediatric brain tumors and acute lymphoblastic leukemia, significantly improving survival outcomes. However, it is often associated with complications, including neurodevelopmental disorders, endocrine dysfunctions, and obesity. This review explores the endocrine complications linked to cranial irradiation, focusing on its impact on the pituitary gland, hypothalamus, salivary glands, and thyroid gland. We discuss how radiation-induced hormonal imbalances contribute to growth restriction, obesity, and reproductive dysfunctions, with an emphasis on gender-specific differences in these outcomes. The underlying mechanisms likely involve the heightened radiation sensitivity in the hypothalamus and pituitary gland, leading to complex disruptions in hormonal regulation. Understanding these mechanisms is essential for developing targeted interventions to reduce long-term endocrine side effects and enhance quality of life for survivors.