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
...Ma...
Figure 1. Common Hypothalamic Pituita...
...Short Stature/...
...Diagnosis and Monito...
...crine Society (ES) recommends prospecti...
...S recommends measuring standing height and...
...Treatment of S...
...gests against using growth hormone...
...uggests against treatment with gro...
...Growth Hor...
...Diagnosis of Gro...
...ecommends lifelong periodic clinical asses...
...gainst relying solely on serum insulin-like gr...
...advises using the same provocative testing to dia...
...against the use of growth hormone-releasing...
...against using spontaneous growth hormone s...
ES recommends that formal testing to establis...
...retesting adult cancer survivors exposed...
...Trea...
...offering growth hormone treatment in childhood c...
...S suggests waiting until the patient...
...cer survivors who have chronic stable...
...vises treating growth hormone-deficie...
...Central Precocious Pu...
...Dia...
...s periodically assessing childhood cancer surv...
...ends against using testicular volume...
...recommends measuring serum testosterone, prefe...
...that the indications and the type of t...
...Hypogonadotropic Hypo...
...Diagnosis of L...
...S recommends screening for luteinizing...
...ing the same strategies to diagnose luteinizing...
...advises following the same treatment appr...
...Centr...
...Diagnos...
...nds lifelong annual screening for thyroid-stimu...
ES advises using the same biochemical test...
...nds against using serum triiodothyronine...
...Treatment of T...
...s using the same approach to treat thyroid-stimula...
Adrenocort...
...Diagnosing A...
...nds lifelong annual screening for adreno...
...gests screening for adrenocorticotropic h...
...using the same screening and dynamic...
...dvises that clinicians use the same g...
...that clinicians instruct all patients wi...
...ished Risk Factors of Short Stature and HP Dysf...