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Ichelle Maa van Roessel Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands

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Boudewijn Bakker Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands

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Hanneke M van Santen Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands

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Wassim Chemaitilly Division of Pediatric Endocrinology, UPMC Children’s Hospitalof Pittsburgh, Pittsburgh, Pennsylvania, USA

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Introduction Endocrine disorders affect up to 60% of childhood cancer survivors (CCS) ( 1 ). Cancer, brain tumors and their treatments have been associated with a higher risk of deficiencies in growth hormone (GH), thyroid hormone and sex

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Izabelle Lövgren Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

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Azadeh Abravan Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK

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Abigail Bryce-Atkinson Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

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Marcel van Herk Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK

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cancer survivors following cranial irradiation. GH, growth hormone; TSH, thyroid stimulating hormone; LH/FSH, luteinizing and follicle-stimulating hormone; ACTH, adrenocorticoptropin. ‘Photon’ indicates the use of photon-beam RT, and ‘Proton’ refers to

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Mette Marie Baunsgaard Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark

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Anne Sophie Lind Helligsoe Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark

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Louise Tram Henriksen Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark

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Torben Stamm Mikkelsen Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark

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Michael Callesen Department of Paediatrics, Odense University Hospital, Odense, Funen, Denmark

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Britta Weber The Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark

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Henrik Hasle Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark

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Niels Birkebæk Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark

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survivors of other childhood cancers, childhood brain tumor survivors are among those at highest risk of both cognitive and physical sequelae ( 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ). Endocrine complications are, however, some of the most frequent

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David S McLaren Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospital NHS Trust, Leeds, UK

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Aarani Devi Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK

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Nikolaos Kyriakakis Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospital NHS Trust, Leeds, UK

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Michelle Kwok-Williams Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK

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Robert D Murray Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospital NHS Trust, Leeds, UK
Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK

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Background Improvements in childhood and young adult (CAYA; 0–24 years) cancer therapy have led to dramatic improvements in survival in the last few decades of the 20th century; however, recent improvements in survival rates have been more

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I M A A van Roessel Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands

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J E Gorter Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands

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B Bakker Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands

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M M van den Heuvel-Eibrink Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands

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M H Lequin Department of Radiology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
Department of Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

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J van der Lugt Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands

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L Meijer Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands

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A Y N Schouten-van Meeteren Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands

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H M van Santen Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands

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Introduction Endocrine complications are common in up to 60% of childhood cancer survivors (CCS) ( 1 ). Deprived bone health, ranging from low bone mineral density (BMD) to bone pain and fractures, is a prevalent late effect, and brain tumor

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S R Ali Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK

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J Bryce Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK

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A L Priego-Zurita Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

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M Cherenko Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

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C Smythe Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK

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T M de Rooij Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

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M Cools Department of Internal Medicine and Paediatrics, Ghent University, Belgium
Department of Paediatric Endocrinology, Ghent University Hospital, Ghent, Belgium

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T Danne Diabetes Center AUF DER BULT, Hannover, Germany

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H Katugampola UCL GOS Institute of Child Health, London

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O M Dekkers Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
Department of Medicine & Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands

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O Hiort Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany

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A Linglart AP-HP, Université Paris Saclay, INSERM, Bicêtre Paris Saclay Hospital, le Kremlin Bicêtre, France

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I Netchine Sorbonne Université, Inserm, Centre de recherche Sainte Antoine, APHP, Hôpital des Enfants Armand Trousseau, Paris, France

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A Nordenstrom Pediatric Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

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P Attila Clinical Genetics and Endocrinology Laboratory, Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary

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L Persani Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, Italy
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy

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N Reisch Endokrinologie, Medizinische Klinik Innenstadt und Poliklinik IV, Klinikum der Universität München, Munich, Germany

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A Smyth Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK

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Z Sumnik Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

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D Taruscio National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy

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W E Visser Erasmus Medical Centre, Department of Internal Medicine, Academic Centre for Thyroid Diseases, Rotterdam, the Netherlands

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A M Pereira Department of Endocrinology and Metabolism, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, the Netherlands

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N M Appelman-Dijkstra Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

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S F Ahmed Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK
Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands

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133 (10%) 1230 (90%) 1363 22 (5, 27) 0.6 (0, 38) 7.2  Thyroid 17 89 (25%) 260 (75%) 349 22 (2, 27) 0.2 (0, 6.3) 2.4 Adults (≥18 years)  Adrenal 17 230 (23%) 751 (77%) 981 24 (5, 27) 1

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Dan Liang Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Han Chen Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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Li-Yong Zhong Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

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hypothalamic–pituitary–thyroid axis (HPT): the basal free thyroxine level was below the reference values (7.64–16.3 pmol/L), while the thyroid-stimulating hormone level was lower, normal, or slightly higher than the reference values (0.49–4.91uIU

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Kirsten Davidse Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Anneloes van Staa Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands

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Wanda Geilvoet Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Judith P van Eck Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Karlijn Pellikaan Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Janneke Baan Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Anita C S Hokken-Koelega Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
Dutch Growth Research Foundation, Rotterdam, the Netherlands

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Erica L T van den Akker Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Theo Sas Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
Diabeter, National Diabetes Care and Research Centre, Rotterdam, the Netherlands

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Sabine E Hannema Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands

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Aart Jan van der Lely Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands

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Laura C G de Graaff Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands

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improve transition ( n  = 10), had an intellectual disability and transferred to ID-care ( n = 28) or died ( n  = 8, mostly cancer-related). Another 49 patients were referred to another hospital or to the general practitioner. Figure 1 Inclusion and

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I M A A van Roessel Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

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J P de Graaf Dutch Pituitary Foundation, Nijkerk, The Netherlands
Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
Endo-ERN European Reference Network on Rare endocrine conditions

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N R Biermasz Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
Endo-ERN European Reference Network on Rare endocrine conditions

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E Charmandari Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece
Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece

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H M van Santen Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

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was present in 79.3% of the patients, thyroid-stimulating hormone deficiency in 89.5%, adrenocorticotropic hormone deficiency in 86.1% and luteinizing hormone/follicle-stimulating hormone deficiency in 77.6%. Posterior pituitary deficiency (arginine

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Julia Beckhaus Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany
Division of Epidemiology and Biometry, Carl von Ossietzky University, Oldenburg, Germany

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Svenja Boekhoff Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany

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Katrin Scheinemann Pediatric Hematology-Oncology Center, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
Department of Pediatrics, McMaster Children’s Hospital and McMaster University, Hamilton, Ontario, Canada

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Freimut H Schilling Department of Pediatrics, Division of Pediatric Hematology and Oncology, Children’s Hospital Lucerne, Lucerne, Switzerland

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Gudrun Fleischhack Pediatrics III, University Hospital of Essen, Essen, Germany

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Gerhard Binder University Children’s Hospital, Pediatric Endocrinology, University Tübingen, Tübingen, Germany

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Brigitte Bison Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany

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Torsten Pietsch Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany

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Carsten Friedrich Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany

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Hermann L Müller Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University, Klinikum Oldenburg AöR, Oldenburg, Germany

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increases the risk of cardiovascular complications and may result in a shorter life expectancy compared to a healthy population of the same age ( 16 , 17 , 18 , 19 ). In contrast to other cancer survivors, children with childhood-onset CP suffer from

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