Management
Treatment of Thyroid-Stimulating Hormone Deficiency
➤ ES advises using the same approach to treat thyroid-stimulating hormone
deficiency in childhood cancer survivors as is used in the noncancer
population. (UGPS)
Adrenocorticotropic Hormone Deficiency
Diagnosing Adrenocorticotropic Hormone Deficiency
➤ ES recommends lifelong annual screening for adrenocorticotropic
hormone deficiency in childhood cancer survivors treated for tumors in the
hypothalamic-pituitary region and in those exposed to ≥30 Gy hypothalamic-
pituitary radiation. (1|⊕⊕⊕
)
➤ ES suggests screening for adrenocorticotropic hormone deficiency
in childhood cancer survivors exposed to between ≥24 Gy and 30 Gy
hypothalamic-pituitary radiation who are >10 years postradiation or develop
clinical symptoms suggestive of adrenocorticotropic hormone deficiency.
(2|⊕
)
➤ ES advises using the same screening and dynamic testing procedures to
diagnose adrenocorticotropic hormone deficiency in childhood cancer
survivors as are used in the noncancer population. (UGPS)
Technical remark: Clinicians should consider the influence of oral estrogen on total cortisol
levels, as it can increase cortisol-binding globulin raising total, but not free, cortisol levels.
Treating Adrenocorticotropic Hormone Deficiency
➤ ES advises that clinicians use the same glucocorticoid regimens as
replacement therapy in childhood cancer survivors with adrenocorticotropic
hormone deficiency as are used in the noncancer population with
adrenocorticotropic hormone deficiency. (UGPS)
➤ ES recommends that clinicians instruct all patients with adrenocorticotropic
hormone deficiency regarding stress dose and emergency glucocorticoid
administration and instruct them to obtain an emergency card/bracelet/
necklace regarding adrenal insufficiency and an emergency kit containing
injectable high-dose glucocorticoid. (1|⊕⊕⊕
)
