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Hypothalamic Pituitary and Growth Disorders

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• 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. Key Points Figure 1. Common Hypothalamic Pituitary Late Effects in Survivors Of Childhood Cancer Hypothalamic / Pituitary Radiotherapy Dose ≥10 Gy Single Fraction Total Body ≥12 Gy Fractionated Total Body ≥30 Gy Cranial ≥18 Gy and <30 Gy Cranial Growth Hormone Deficiency Growth Hormone Deficiency Central Precocious Puberty LH/FSH Deficiency a TSH Deficiency a ACTH Deficiency a Growth Hormone Deficiency Central Precocious Puberty Tumor Growth and/or Surgery Near the Hypothalamus / Pituitary b a Deficiencies in LH/FSH, TSH and/or ACTH may appear aer treatment with lower doses of radiotherapy with longer follow-up. b Tumor and surgery-induced damage may acutely cause multiple hypothalamic-pituitary deficits in addition to central diabetes insipidus. Management

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