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...
...Hypothalamic Pituitary Late Effects in S...
...Short Stature/Impai...
...Diagnosis and...
...rine Society (ES) recommends prospective f...
...mends measuring standing height an...
...Treatment of...
...against using growth hormone in cancer...
...uggests against treatment with growth hormo...
...Growth...
...Diagnosis of Growth Hor...
...mmends lifelong periodic clinical a...
...gainst relying solely on serum insuli...
...sing the same provocative testing to diagnose...
...ends against the use of growth hormone-releasing...
...S suggests against using spontaneous growth...
...ds that formal testing to establish a diagn...
ES recommends retesting adult cancer survivor...
...Treatment of Growth Horm...
...ffering growth hormone treatment i...
...ts waiting until the patient has b...
...dhood cancer survivors who have chr...
...ting growth hormone-deficient childhood cancer...
...Central Preco...
...commends periodically assessing childhoo...
...mends against using testicular volume as the p...
...ends measuring serum testosterone, pre...
...Treatment...
...vises that the indications and the type of treatm...
...Hypogonadotro...
...s screening for luteinizing hormone/...
...advises using the same strategies to...
...Treatment of...
...advises following the same treatment approach...
Central H...
...D...
...recommends lifelong annual screen...
...ing the same biochemical tests to screen for...
...commends against using serum triiodothyronine,...
...Treatment...
...S advises using the same approach to...
...Adrenoco...
...Dia...
...nds lifelong annual screening for adrenoc...
...suggests screening for adrenocorti...
...es using the same screening and dynam...
...Treating Adrenocortico...
...vises that clinicians use the same...
...nds that clinicians instruct all patients...
.... Established Risk Factors of Short Stature and...