• 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
