Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer

Full Guideline: Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline
JCEM | August 2018
Charles A. Sklar (chair), Zoltan Antal, Wassim Chemaitilly, Laurie E. Cohen, Cecilia Follin, Lillian Meacham, M. Hassan Murad

The 2018 guideline on hypothalamic–pituitary and growth disorders in survivors of childhood cancer:

  • Provides recommendations for the diagnosis and treatment of hypothalamic-pituitary abnormalities and management of impaired growth in childhood cancer survivors
  • Emphasizes improving the quality of life and reducing morbidity of cancer survivors
  • Prioritizes routine lifelong follow-up with an appropriate specialist


Resources



Essential Points

  • Establishes a framework for the appropriate diagnosis and treatment of these high-risk individuals;
  • 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 GH deficiency and precocious puberty whereas deficits of LH/FSH, TSH and 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.


List of Recommendations

+ 1.0 SHORT STATURE/IMPAIRED LINEAR GROWTH IN CHILDHOOD CANCER SURVIVORS

+ 2.0 GROWTH HORMONE DEFICIENCY IN CHILDHOOD CANCER SURVIVORS

+ 3.0 CENTRAL PRECOCIOUS PUBERTY IN CHILDHOOD CANCER SURVIVORS

+ 4.0 HYPOGONADOTROPIC HYPOGONADISM IN CHILDHOOD CANCER SURVIVORS

+ 5.0 CENTRAL HYPOTHYROIDISM—THYROID-STIMULATING HORMONE DEFICIENCY IN CHILDHOOD CANCER SURVIVORS

+ 6.0 ADRENOCORTICOTROPHIC HORMONE DEFICIENCY IN CHILDHOOD CANCER SURVIVORS