Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer
Key Points
Key Points
Radiation-induced hypothalamic-pituitary dysfunction is both dose- and time-dependent; doses to the hypothalamus-pituitary <30 Gy are associated primarily with growth hormone deficiency (GHD) and precocious puberty whereas deficits of luteinizing hormone/follicle-stimulating hormone (LH/FSH), thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH) are seen following hypothalamic-pituitary doses >30 Gy, often years after completion of cancer therapy.
Impaired linear growth and short adult height are most common in survivors exposed at a young age to central nervous system, spinal, or total body irradiation.
While the testing for and treatment of many of these disorders in cancer survivors are like that in the non-cancer population, the guideline emphasizes key differences and unique features/findings that are specific to the cancer survivor.
Management
Management
...gure 1. Common Hypothalamic Pituitary Late Effec...
...ort Stature/Impaired Linear...
...Monitoring of Short Stature/Impaired Linear...
...docrine Society (ES) recommends prospective...
...easuring standing height and sittin...
...atment of Short Stature/Impaired Linear...
...gainst using growth hormone in cancer survivors...
...nst treatment with growth hormone in childr...
...wth Hormone Deficiency...
...s of Growth Hormone Deficienc...
...felong periodic clinical assessment fo...
...recommends against relying solely on serum insulin...
ES advises using the same provocative testing...
...s against the use of growth hormone-re...
...nst using spontaneous growth hormone secr...
...hat formal testing to establish a diagno...
...testing adult cancer survivors exposed to hy...
...eatment of Growth Hormone Deficiency
ES recommends offering growth hormone...
...suggests waiting until the patient...
...childhood cancer survivors who have chronic stable...
...S advises treating growth hormone-...
...al Precocious Puber...
...s of Central Precocious Pubert...
...s periodically assessing childhood cancer surv...
...ends against using testicular volume as...
...ommends measuring serum testosterone...
...tment of Central Precocious Pubert...
...t the indications and the type of treatm...
...otropic Hypogonadism...
...Luteinizing Hormone/Follicle-Stimulating Ho...
...nds screening for luteinizing hormo...
...ises using the same strategies to diagn...
...nt of Luteinizing Hormone/Follicle...
...advises following the same treatment...
...thyroidism – Thyroid-Stimulating Hormo...
...of Central Hypothyroidism...
...ifelong annual screening for thyroid-stimulat...
...g the same biochemical tests to screen for...
...ends against using serum triiodothyron...
...f Thyroid-Stimulating Hormone Deficie...
...using the same approach to treat thyroid-sti...
...rticotropic Hormone Deficiency...
...iagnosing Adrenocorticotropic Hormone Deficien...
...ommends lifelong annual screening for adreno...
...screening for adrenocorticotropic...
...dvises using the same screening and dynamic t...
...ing Adrenocorticotropic Hormone Defi...
...t clinicians use the same glucocorticoid reg...
...ds that clinicians instruct all patients with adre...
...lished Risk Factors of Short Stature and...