Recommend prospective follow-up of linear growth for childhood cancer survivors at high risk for short adult height, namely those exposed to cranial radiation therapy, craniospinal irradiation, or total body irradiation at a young age and those with a history of inadequate weight gain or prolonged steroid requirement.
Recommend measuring standing height and sitting height in childhood cancer survivors treated with radiation that included the spine (ie, total body irradiation, craniospinal irradiation, as well as radiation to the chest, abdomen, or pelvis).
Suggest against using growth hormone in cancer survivors who do not have growth hormone deficiency to treat for short stature and/or poor linear growth following spinal irradiation.
Suggest against treatment with growth hormone in children with short stature and/or impaired linear growth who are being treated with tyrosine kinase inhibitors.
Recommend lifelong periodic clinical assessment for growth hormone deficiency in survivors treated for tumors in the region of the hypothalamic–pituitary axis and in those exposed to hypothalamic–pituitary axis radiation treatment ≥18 Gy (eg, various brain tumors, nasopharyngeal carcinoma, acute lymphoblastic leukemia, lymphoma).
Recommend against the use of growth hormone–releasing hormone alone or in combination with arginine in childhood cancer survivors to diagnose growth hormone deficiency after hypothalamic–pituitary axis radiation.
Recommend offering growth hormone treatment in childhood cancer survivors with confirmed growth hormone deficiency based on the safety and efficacy demonstrated in that population.
Suggest waiting until the patient has been 1 year disease-free, following completion of therapy for malignant disease, before initiating growth hormone treatment.
Recommend periodically assessing childhood cancer survivors for evidence of central precocious puberty if they have a history of hydrocephalus or tumors developing in or near the hypothalamic region and/or have been exposed to hypothalamic–pituitary radiation.
Recommend measuring serum testosterone, preferably using liquid chromatography–tandem mass spectroscopy, and luteinizing hormone levels prior to 10:00 AM to complement the clinical assessment of male childhood cancer survivors who are suspected of or are at risk for developing central precocious puberty and were exposed to gonadotoxic treatments.
Recommend screening for luteinizing hormone/follicle-stimulating hormone deficiency in childhood cancer survivors exposed to hypothalamic–pituitary axis radiation at doses ≥30 Gy and in those with a history of tumors or surgery affecting the hypothalamic–pituitary axis region.
Recommend lifelong annual screening for thyroid-stimulating hormone deficiency in childhood cancer survivors treated for tumors in the region of the hypothalamic–pituitary axis and those exposed to ≥30 Gy hypothalamic–pituitary radiation.
Recommend lifelong annual screening for adrenocorticotropic hormone deficiency in childhood cancer survivors treated for tumors in the hypothalamic–pituitary region and in those exposed to ≥30 Gy hypothalamic–pituitary radiation.
Recommend that clinicians instruct all patients with adrenocorticotropic hormone deficiency regarding stress dose and emergency glucocorticoid administration and instruct them to obtain an emergency card/bracelet/necklace regarding adrenal insufficiency and an emergency kit containing injectable high-dose glucocorticoid.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Endocrine Effects after Childhood Cancer Clinical Practice Guidelines (2018) - Medscape - Aug 09, 2018.