Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer

Publication Date: June 29, 2018

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

...anagemen...

Figure 1. Common Hypothalamic Pituitary...


Short Stature/Impaired Li...

...gnosis and Monitoring of Short Stature/Impaired...

...e Society (ES) recommends prospective follow-up o...

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

...ment of Short Stature/Impaired Linear Growth...

...gests against using growth hormone in cancer...

...sts against treatment with growth hormone in...


...owth Hormone Defici...

...iagnosis of Growth Hormone Deficiency...

...recommends lifelong periodic clinical as...

...ainst relying solely on serum insulin-lik...

...sing the same provocative testing to diagno...

...S recommends against the use of grow...

...uggests against using spontaneous gr...

...that formal testing to establish a diagnosi...

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

...atment of Growth Hormone Def...

...mends offering growth hormone treatment i...

...S suggests waiting until the patient has been...

...ood cancer survivors who have chroni...

...s treating growth hormone-deficient childho...


...entral Precocious Puberty...

...agnosis of Central Precocious...

...recommends periodically assessing childh...

...against using testicular volume as the prima...

...ecommends measuring serum testosterone, p...

...f Central Precocious Pubert...

...S advises that the indications and the...


...onadotropic Hypogonadis...

...iagnosis of Luteinizing Hormone/Foll...

...recommends screening for luteinizing ho...

...ing the same strategies to diagnose lutein...

...nt of Luteinizing Hormone/Follicle-Stimulating Hor...

...following the same treatment approach to lutein...


...Hypothyroidism – Thyroid-Stimulating...

...is of Central Hypothyroidism...

...recommends lifelong annual screening for th...

...ises using the same biochemical tests to screen...

...recommends against using serum triiodothyronine,...

...t of Thyroid-Stimulating Hormone Deficiency...

...ises using the same approach to treat...


...nocorticotropic Hormone Deficiency...

...Adrenocorticotropic Hormone Deficiency...

...recommends lifelong annual screening f...

...suggests screening for adrenocortic...

...ing the same screening and dynamic testing...

...Adrenocorticotropic Hormone Deficien...

...clinicians use the same glucocorticoid r...

...S recommends that clinicians instruct al...

...ablished Risk Factors of Short Stature...