➤ ES recommends measuring serum testosterone, preferably using liquid
chromatography-tandem mass spectroscopy, and luteinizing hormone levels
prior to 10:00 AM to complement the clinical assessment of male childhood
cancer survivors who are suspected of or are at risk for developing central
precocious puberty and were exposed to gonadotoxic treatments. (1|⊕⊕
)
Technical remark: Clinicians need to interpret plasma luteinizing hormone levels in
patients exposed to gonadotoxic treatments in the context of their medical history and
physical examination. Elevated luteinizing hormone levels in such patients may be due to
primary gonadal injury rather than to the onset of central puberty.
Treatment of Central Precocious Puberty
➤ ES advises that the indications and the type of treatment regimens for central
precocious puberty in childhood cancer survivors should be similar to those
used for central precocious puberty in the noncancer population. (UGPS)
Hypogonadotropic Hypogonadism
Diagnosis of Luteinizing Hormone/Follicle-Stimulating Hormone
Deficiency
➤ ES recommends screening for luteinizing hormone/follicle-stimulating
hormone deficiency in childhood cancer survivors exposed to hypothalamic-
pituitary axis radiation at doses ≥30 Gy and in those with a history of tumors
or surgery affecting the hypothalamic-pituitary axis region. (1|⊕⊕⊕
)
➤ ES advises using the same strategies to diagnose luteinizing hormone/
follicle-stimulating hormone deficiency in childhood cancer survivors as are
used in the noncancer population. (UGPS)
Treatment of Luteinizing Hormone/Follicle-Stimulating Hormone
Deficiency
➤ ES advises following the same treatment approach to luteinizing hormone/
follicle-stimulating hormone deficiency in childhood cancer survivors as is
appropriate in the noncancer population. (UGPS)
Central Hypothyroidism – Thyroid-Stimulating Hormone
Deficiency
Diagnosis of Central Hypothyroidism
➤ ES recommends lifelong annual screening for thyroid-stimulating hormone
deficiency in childhood cancer survivors treated for tumors in the region of
the hypothalamic-pituitary axis and those exposed to ≥30 Gy hypothalamic-
pituitary radiation. (1|⊕⊕⊕
)
➤ ES advises using the same biochemical tests to screen for thyroid-stimulating
hormone deficiency in childhood cancer survivors as are used in the
noncancer population. (UGPS)
➤ ES recommends against using serum triiodothyronine, thyroid-stimulating
hormone surge analysis, or thyrotropin-releasing hormone stimulation to
diagnose thyroid-stimulating hormone deficiency. (1|⊕⊕
)
