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
...anagement...
...ommon Hypothalamic Pituitary Late Effects...
...t Stature/Impaired Linear Growth...
...Monitoring of Short Stature/Impaired Li...
...ne Society (ES) recommends prospectiv...
...mmends measuring standing height and si...
...Short Stature/Impaired Linear Growth...
...suggests against using growth hormone in c...
...inst treatment with growth hormone in...
...rowth Hormone Deficienc...
...s of Growth Hormone Deficiency...
...ds lifelong periodic clinical assessment for growt...
...S recommends against relying solely on seru...
...ng the same provocative testing to diagnose gro...
ES recommends against the use of gro...
...ts against using spontaneous growth...
...mmends that formal testing to establish a diag...
...retesting adult cancer survivors ex...
...of Growth Hormone Deficiency
...ecommends offering growth hormone tr...
...sts waiting until the patient has been 1 year...
...cancer survivors who have chronic stable disease...
ES advises treating growth hormone-deficient...
...entral Precocious Puberty
...agnosis of Central Precocious Puberty...
...ends periodically assessing childho...
...mmends against using testicular volume as...
...measuring serum testosterone, preferably...
Treatment of Central Precocious Pubert...
...that the indications and the type of trea...
...gonadotropic Hypogonadism...
...Luteinizing Hormone/Follicle-Stimulating Hormone...
...commends screening for luteinizing hormone/fol...
...using the same strategies to diagnose luteinizing...
...of Luteinizing Hormone/Follicle-Stim...
...es following the same treatment approach...
...l Hypothyroidism – Thyroid-Stimula...
...nosis of Central Hypothyroid...
...ecommends lifelong annual screening for th...
...using the same biochemical tests to screen for th...
...recommends against using serum triio...
...t of Thyroid-Stimulating Hormone Deficienc...
...dvises using the same approach to treat thyroid-s...
...ocorticotropic Hormone Deficiency...
...g Adrenocorticotropic Hormone Deficiency...
...ommends lifelong annual screening for adrenoco...
...screening for adrenocorticotropic hormone defic...
...ses using the same screening and dyna...
...drenocorticotropic Hormone Deficiency...
...that clinicians use the same glucocorticoid...
...that clinicians instruct all patients wi...
...Established Risk Factors of Short Stature and...