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

...nagemen...

...n Hypothalamic Pituitary Late Effe...


...rt Stature/Impaired Line...

...agnosis and Monitoring of Short Stature/Imp...

...Society (ES) recommends prospectiv...

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

...ort Stature/Impaired Linear Growth...

...ts against using growth hormone in cancer s...

...S suggests against treatment with growth h...


...rowth Hormone Def...

...gnosis of Growth Hormone Deficiency

...ds lifelong periodic clinical assessment for gr...

...ecommends against relying solely on serum insuli...

ES advises using the same provocative...

...against the use of growth hormone-releas...

...ggests against using spontaneous growth hormone se...

...hat formal testing to establish a...

...retesting adult cancer survivors exposed to hy...

...reatment of Growth Hormone...

...recommends offering growth hormone tr...

...ing until the patient has been 1 year disease-free...

...dhood cancer survivors who have chronic st...

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


...tral Precocious Pubert...

...agnosis of Central Precocious...

...s periodically assessing childhood canc...

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

...mends measuring serum testosterone, preferab...

...nt of Central Precocious Pu...

...t the indications and the type of t...


...nadotropic Hypogonadism

...teinizing Hormone/Follicle-Stimulating Hormone Def...

ES recommends screening for luteinizing hormone/f...

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

Treatment of Luteinizing Hormone/Follicle-Stimulat...

...ises following the same treatment approach...


...ypothyroidism – Thyroid-Stimulating Hormon...

...sis of Central Hypothyro...

...ifelong annual screening for thyroid-stimu...

...ing the same biochemical tests to screen for thyr...

...mmends against using serum triiodothyronine, t...

...ment of Thyroid-Stimulating Hormone Defic...

...dvises using the same approach to treat...


...corticotropic Hormone Deficiency...

...agnosing Adrenocorticotropic Hormo...

...ends lifelong annual screening for...

...ening for adrenocorticotropic hormone deficiency...

...using the same screening and dynamic...

...enocorticotropic Hormone Deficiency...

...ises that clinicians use the same glu...

...ommends that clinicians instruct all patients wit...

Table 1. Established Risk Factors o...