Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer
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
...nagement...
...1. Common Hypothalamic Pituitary Late Effects...
...e/Impaired Linear Growth...
...and Monitoring of Short Stature/Impaire...
...iety (ES) recommends prospective follo...
...S recommends measuring standing height and sit...
...ment of Short Stature/Impaired Linear Gr...
...uggests against using growth hormone in cancer...
...gests against treatment with growth h...
...Hormone Deficienc...
...nosis of Growth Hormone Def...
...ifelong periodic clinical assessment for g...
...s against relying solely on serum insulin-like...
...S advises using the same provocative testing...
...recommends against the use of growth...
...inst using spontaneous growth hormone se...
...nds that formal testing to establish a d...
ES recommends retesting adult cancer survivors...
...atment of Growth Hormone Deficien...
...s offering growth hormone treatment in childhood c...
...gests waiting until the patient has been 1 year di...
...cancer survivors who have chronic stable dise...
...vises treating growth hormone-deficient childhood...
...al Precocious Puberty
...is of Central Precocious Pube...
ES recommends periodically assessing childhood...
...commends against using testicular volume...
...nds measuring serum testosterone,...
...nt of Central Precocious Pube...
...that the indications and the type of trea...
...ogonadotropic Hypogo...
...uteinizing Hormone/Follicle-Stimulating Hormone De...
...s screening for luteinizing hormone/folli...
...ng the same strategies to diagnose luteinizing...
...ment of Luteinizing Hormone/Follicle-Stimul...
...owing the same treatment approach to lutein...
...l Hypothyroidism – Thyroid-Stimulating Hormo...
...iagnosis of Central Hypothy...
...recommends lifelong annual screening for thy...
...ng the same biochemical tests to screen for th...
...recommends against using serum triiod...
...atment of Thyroid-Stimulating Hormone De...
...es using the same approach to treat thyroi...
...nocorticotropic Hormone Deficiency...
...nosing Adrenocorticotropic Hormone Deficiency...
...felong annual screening for adrenocorticotropi...
...reening for adrenocorticotropic hormo...
...sing the same screening and dynamic testing pr...
...ng Adrenocorticotropic Hormone Deficiency...
...clinicians use the same glucocorticoid regimen...
...S recommends that clinicians instru...
...1. Established Risk Factors of Short Stature...