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Hypothalamic Pituitary and Growth Disorders

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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)

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