Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer

Last updated April 8, 2022

Key Points

Key Points

Hypothalamic-pituitary dysfunction is frequently observed in childhood cancer survivors, especially those with tumors involving the hypothalamic-pituitary region or those previously exposed to radiation to the central nervous system.

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

Mana...

...e 1. Common Hypothalamic Pituitary Lat...


...Short Stature/Impaired Lin...

...Diagnosis and Mo...

...e Society (ES) recommends prospective fo...

...ds measuring standing height and sitting height...

...Treatment of Short Stat...

...suggests against using growth hormone i...

...uggests against treatment with grow...


...Growth Horm...

...Diagnosis of...

...recommends lifelong periodic clinical ass...

...s against relying solely on serum i...

...es using the same provocative testing to diagnos...

...ommends against the use of growth hormone-relea...

...inst using spontaneous growth hormone secre...

...s that formal testing to establish a diagno...

...ds retesting adult cancer survivors exposed...

...Treatment of Growth Horm...

...recommends offering growth hormone trea...

...s waiting until the patient has bee...

...ldhood cancer survivors who have chronic stable d...

...dvises treating growth hormone-deficient c...


...Central Prec...

...Diagnosis of Central Preco...

ES recommends periodically assessing childh...

...gainst using testicular volume as the...

...asuring serum testosterone, preferably usi...

...Treatmen...

...advises that the indications and the type...


H...

...Diagnosis of L...

...ends screening for luteinizing hormone/follic...

...using the same strategies to diagnose...

...Tre...

ES advises following the same trea...


...Central Hypothyroidism –...

...Diagnosis of...

...ommends lifelong annual screening for thyroi...

...es using the same biochemical tests to screen f...

...commends against using serum triiodothyr...

...Treatment o...

...ses using the same approach to treat thyroid-sti...


...Adrenoc...

...Diagnosin...

...recommends lifelong annual screening for adre...

...eening for adrenocorticotropic hormone defi...

...ing the same screening and dynamic t...

...Treating Adreno...

...advises that clinicians use the same glucocorticoi...

...hat clinicians instruct all patients wit...

...stablished Risk Factors of Short St...