Guideline Addresses Endocrine Effects After Childhood Cancer

Marcia Frellick

July 03, 2018

The Endocrine Society has issued a new clinical practice guideline advising healthcare providers on how to diagnose and treat hypothalamic-pituitary and growth disorders in survivors of childhood cancer.

Owing to treatment advances, the numbers of survivors of childhood cancer are growing. Current 5-year survival rates have passed 80%, the guideline authors note. Data show that almost half of childhood cancer survivors will develop an endocrine disorder.

"The guideline stresses the importance of lifelong screening of these survivors for earlier detection and optimal patient care," Charles A. Sklar, MD, of the Memorial Sloan Kettering Cancer Center in New York City and chair of the committee that developed the guidelines, said in a press release from the Endocrine Society.

It is estimated that there will be nearly half a million childhood cancer survivors in the United States by 2020. And even decades after cancer, this population faces a higher risk for medical complications, often as a result of treatments, including radiation exposure.

"Radiation exposure to key endocrine organs (eg, hypothalamus, pituitary, thyroid and gonads) is the single most important risk factor and puts survivors at extremely high risk of developing an endocrine abnormality over time....

"Importantly, radiation-induced abnormalities are, in general, both dose- and time-dependent such that the higher the dose and the longer the interval following treatment, the greater the risk. Thus, endocrine disorders may not develop for decades after completion of cancer treatment, underscoring the critical importance of lifelong surveillance for those at risk," the guidelines emphasize.

One of the key recommendations is for long-term screening of childhood cancer survivors whose brains were exposed to radiation.

Assessments are needed specifically for growth disorders, central precocious puberty, central hypothyroidism/thyroid stimulating hormone deficiency, and adrenal corticotropin hormone deficiency, according to the guideline.

If a condition is diagnosed, in most cases, clinicians should treat these survivors the way other patients who develop endocrine conditions are treated.

The guideline was published online June 29 in the Journal of Clinical Endocrinology and Metabolism.

Other members of the Endocrine Society writing committee include Zoltan Antal, New York Presbyterian Hospital, Weill Cornell Medical College, and the Memorial Sloan Kettering Cancer Center in New York City; Wassim Chemaitilly, St. Jude Children's Research Hospital, Memphis, Tennessee; Laurie E. Cohen, Boston Children's Hospital, Massachusetts; Cecilia Follin, Skane University Hospital, Lund, Sweden; Lillian R. Meacham, Emory University School of Medicine, Atlanta, Georgia; and M. Hassad Murad, Mayo Clinic, Rochester, Minnesota.

The Endocrine Society does not solicit or accept corporate support for its guidelines. All clinical practice guidelines are supported entirely by Society funds. The authors have disclosed no relevant financial relationships.

J Clin Endocrinol Metab. Published online June 29, 2018. Abstract

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