Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer

An Endocrine Society Clinical Practice Guideline

Charles A. Sklar; Zoltan Antal; Wassim Chemaitilly; Laurie E. Cohen; Cecilia Follin; Lillian R. Meacham; M. Hassan Murad


J Clin Endocrinol Metab. 2018;103(8):2761-2784. 

In This Article

Method of Development of Evidence-based Clinical Practice Guidelines

GRADE Approach

The guideline writing committee followed the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group, an international group with expertise in the development and implementation of evidence-based guidelines.[181] A detailed description of the grading scheme has been published elsewhere.[182] The writing committee used the best available research evidence to develop the recommendations. The writing committee also used consistent language and graphical descriptions of both the strength of a recommendation and the quality of evidence. In terms of the strength of a recommendation, strong recommendations use the phrase "we recommend" and the number 1, and conditional recommendations use the phrase "we suggest" and the number 2. Cross-filled circles indicate the quality of the evidence, such that ⊕OOO denotes very low–quality evidence; ⊕⊕OO, low quality; ⊕⊕⊕O, moderate quality; and ⊕⊕⊕⊕, high quality. The writing committee has confidence that persons who receive care according to the strong recommendations will derive, on average, more benefit than harm. Conditional recommendations require more careful consideration of the person's circumstances, values, and preferences to determine the best course of action. Linked to each recommendation is a description of the evidence and the values that the writing committee considered in making the recommendation. In some instances, there are remarks in which the writing committee offers technical suggestions for testing conditions, dosing, and monitoring. These technical comments reflect the best available evidence applied to a typical person being treated. Often this evidence comes from the unsystematic observations of the writing committee and their preferences; therefore, one should consider these remarks as suggestions.

In this guideline, the writing committee made several statements to emphasize the importance of shared decision-making, general preventive care measures, and basic principles of treatment of hypothalamic–pituitary and growth disorders in childhood cancer survivors. They labeled these "Ungraded Good Practice Statement." Direct evidence for these statements was either unavailable or not systematically appraised and considered out of the scope of this guideline. The intention of these statements is to draw attention to these principles.