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
Management
...gure 1. Common Hypothalamic Pituitary Late E...
...ure/Impaired Linear Growth...
...osis and Monitoring of Short Stature/I...
...ociety (ES) recommends prospective...
...ends measuring standing height and sitting h...
...of Short Stature/Impaired Linear Growth...
...gainst using growth hormone in cancer s...
...gests against treatment with growth hormone in chi...
...owth Hormone Deficiency...
...gnosis of Growth Hormone Deficien...
...ommends lifelong periodic clinical assess...
...recommends against relying solely on serum i...
...advises using the same provocative testing...
...gainst the use of growth hormone-rel...
...uggests against using spontaneous grow...
...mends that formal testing to establish a diagnosi...
...ommends retesting adult cancer survivors ex...
...ment of Growth Hormone Defic...
...S recommends offering growth hormone treatment in...
...gests waiting until the patient has been 1...
...ldhood cancer survivors who have chro...
...ses treating growth hormone-defici...
Central Precocious Pu...
...gnosis of Central Precocious Puberty...
...ds periodically assessing childhood cancer surv...
...against using testicular volume as th...
...recommends measuring serum testoste...
...ment of Central Precocious Pube...
...dvises that the indications and the type o...
...otropic Hypogonadism...
...iagnosis of Luteinizing Hormone/Follicle-Stimulat...
...reening for luteinizing hormone/follicle-stimulat...
...g the same strategies to diagnose luteinizing h...
...f Luteinizing Hormone/Follicle-Stimulating Hor...
...llowing the same treatment approach to lutei...
Central Hypothyroidism – Thyroid-Stimulating Ho...
...f Central Hypothyroidism...
ES recommends lifelong annual screening for...
...g the same biochemical tests to screen for th...
...s against using serum triiodothyronine, thyroi...
...reatment of Thyroid-Stimulating Hormone Defi...
...sing the same approach to treat thyroid-stim...
...orticotropic Hormone Deficie...
...Adrenocorticotropic Hormone Deficie...
...felong annual screening for adrenocort...
...reening for adrenocorticotropic hormone...
...g the same screening and dynamic testing...
...reating Adrenocorticotropic Hormone Deficiency...
...ises that clinicians use the same glucocorticoid r...
...ds that clinicians instruct all patients with...
...le 1. Established Risk Factors of Short Stat...