Pituitary basic and neuroendocrinology• Thirty-four (21 women) ALL survivors, on complete hormone supplementation • 34 years after ALL diagnosis.• Median-age: 38 (27-46) years • CRT dose of 24 Gy.• Comparison was made with 31 matched controls.Conclusion ALL women treated with CRT are at high risk of metabolic abnormalities in association with a smaller HT volume 34 years after ALL diagnosis. These findings suggest an hypothalamic effect of the metabolic complications.Background:There is an increased risk for metabolic complications in ALL survivors treated with cranial radiotherapy (CRT). These complications include obesity, lipid abnormalities, insulin resistance and the etiology is not well understood. The hypothalamus (HT) is a small complex area of the brain involved in endocrine function and metabolic control. In ALL survivors, assessment of the volume of the HT in relation to metabolic parameters including ghrelin, an orexigenic peptide stimulating food intake, has not been performed previously.