Management
Short Stature/Impaired Linear Growth
Diagnosis and Monitoring of Short Stature/Impaired Linear Growth
➤ Endocrine Society (ES) recommends 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. (1|⊕⊕⊕
)
➤ ES recommends measuring standing height and sitting height in childhood
cancer survivors treated with radiation that included the spine (i.e., total body
irradiation, craniospinal irradiation, as well as radiation to the chest, abdomen,
or pelvis). (1|⊕⊕
)
Technical remark: Sitting height is measured directly using a sitting height stadiometer,
and the lower segment can be determined by subtracting sitting height from standing height.
Alternatively, the lower segment can be determined by measuring from the pubic symphysis to
the floor, and the upper segment can be determined by subtracting leg length from height. The
upper to lower segment ratio can then be calculated but differs depending on the method used
and ethnicity. In situations where clinicians are unable to measure sitting height, measuring
arm span and comparing it to standing height will provide an estimate of spinal foreshortening
due to prior spinal radiation.
Treatment of Short Stature/Impaired Linear Growth
➤ ES suggests 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. (2|⊕
)
➤ ES suggests against treatment with growth hormone in children with short
stature and/or impaired linear growth who are being treated with tyrosine kinase
inhibitors. (2|⊕
)
Growth Hormone Deficiency
Diagnosis of Growth Hormone Deficiency
➤ ES recommends 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 (e.g., various brain tumors, nasopharyngeal carcinoma, acute
lymphoblastic leukemia, lymphoma). (1|⊕⊕⊕
)
Technical remark: The consensus of the writing committee is to assess height in children every
6 to 12 months.
➤ ES recommends against relying solely on serum insulin-like growth factor-1
levels in childhood cancer survivors exposed to hypothalamic-pituitary axis
radiotherapy to make the diagnosis of growth hormone deficiency. (1|⊕⊕
)
➤ ES advises using the same provocative testing to diagnose growth hormone
deficiency in childhood cancer survivors as are used for diagnosing growth
hormone deficiency in the noncancer population. (UGPS)