➤ ES recommends against the use of growth hormone-releasing hormone alone or
in combination with arginine in childhood cancer survivors to diagnose growth
hormone deficiency after hypothalamic-pituitary axis radiation. (1|⊕⊕
)
➤ ES suggests against using spontaneous growth hormone secretion (e.g., 12-
hour overnight sampling) as a diagnostic test in determining growth hormone
deficiency in childhood cancer survivors. (2|⊕
)
➤ ES recommends that formal testing to establish a diagnosis of growth hormone
deficiency is not required in childhood cancer survivors with three other
confirmed anterior pituitary hormone deficits. (1|⊕⊕
)
➤ ES recommends retesting adult cancer survivors exposed to hypothalamic-
pituitary axis radiation treatment and with a diagnosis of isolated growth
hormone deficiency in childhood. (1|⊕⊕
)
Treatment of Growth Hormone Deficiency
➤ ES recommends offering growth hormone treatment in childhood cancer
survivors with confirmed growth hormone deficiency based on the safety and
efficacy demonstrated in that population. (1|⊕⊕
)
➤ ES suggests waiting until the patient has been 1 year disease-free, following
completion of therapy for malignant disease, before initiating growth hormone
treatment. (2|⊕
)
➤ In childhood cancer survivors who have chronic stable disease and thus may
not ever be "disease-free" (particularly survivors treated for optic pathway
tumors), ES advises discussing the appropriateness of growth hormone
treatment and its timing with their oncologist. (UGPS)
➤ ES advises treating growth hormone-deficient childhood cancer survivors with
similar growth hormone treatment regimens as are appropriate for individuals
with growth hormone deficiency from the noncancer population. (UGPS)
Central Precocious Puberty
Diagnosis of Central Precocious Puberty
➤ ES recommends periodically assessing childhood cancer survivors for evidence
of central precocious puberty if they have a history of hydrocephalus, tumors
developing in or near the hypothalamic region, and/or have been exposed to
hypothalamic-pituitary radiation. (1|⊕⊕⊕
)
➤ ES recommends against using testicular volume as the primary or sole
indicator of degree of sexual development in male childhood cancer survivors
previously treated with gonadotoxic agents, such as alkylating agents or
testicular radiotherapy. (1|⊕⊕⊕
)
Management
