Endocrine Society GUIDELINES Bundle (free trial)

Hypothalamic Pituitary and Growth Disorders

Endocrine Society GUIDELINES Apps brought to you free of charge courtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/1140178

Contents of this Issue


Page 1 of 7

• 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

Articles in this issue

Archives of this issue

view archives of Endocrine Society GUIDELINES Bundle (free trial) - Hypothalamic Pituitary and Growth Disorders