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Healthy living after treatment of childhood, adolescent, and young adult cancer

Precocious Puberty after Cancer Treatment
Some people who were treated for cancer during childhood may develop endocrine (hormone) problems as a result ofchanges in the function of a complex system of glands known as the endocrine system.
Pituitary gland

What is the endocrine system?

Hypothalamus

The endocrine system is a group of glands that regulate
body functions including growth, puberty, energy level, urine
production, and stress response. Glands of the endocrine
system include the pituitary, hypothalamus, thyroid, pancreas,adrenal, ovaries, and testes. The hypothalamus and pituitary
are sometimes called the “master glands” because they control
many of the other glands in the endocrine system. Unfortunately,some treatments given for childhood cancer can damage theendocrine system, resulting in a variety of problems.

ThyroidPancreas
Adrenal glands

Ovaries

What are hormones?

TestesHormones are chemical messengers that carry information fromthe endocrine glands through the bloodstream to the body’scells. The endocrine system makes many hormones (such as growth hormone, sex hormones, adrenal and thyroidhormones) that work together to maintain specific bodily functions.
What is the normal age for puberty to begin?
Puberty normally begins between the ages of 8 and 13 in children born with ovaries, and 9 and 14 in children bornwith testes. The timing of puberty is influenced by a person’s genetic background, and the onset of puberty at a young
age may run in families. Most children born with ovaries begin to develop breasts and then pubic hair at around age 10
or 11. Menstrual periods usually start at around 12 to 13 years of age but may occur earlier or later and still be normal.
Children born with testes usually begin to develop enlargement of the testicles and then pubic hair between 11 and 12years of age.
What is precocious puberty?
Precocious puberty means having signs of puberty (such as pubic hair or breast growth) at an age younger than isnormally expected. Most healthcare providers agree that a child born with ovaries has precocious puberty if sexualtraits develop earlier than age 8, and a child born with testes has precocious puberty if sexual traits develop prior toage 9.
The early release of hormones that cause precocious puberty also causes a growth spurt, with rapid bone growth. Earlybone maturation results in less time for growth, so the child with precocious puberty will have a final adult height thatis actually much shorter than expected.
What are the risk factors for developing precocious puberty?
• Radiation to the head or brain, especially doses of 18 Gy (1800 cGy/rads) or higher• Children with ovaries• Younger age at the time of cancer treatment• Being overweight or obese
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Healthy living after treatment of childhood, adolescent, and young adult cancer

Why does precocious puberty happen?
The hypothalamus and pituitary gland in the brain may be damaged after radiation treatments. The damage causes
them to signal the ovaries or testicles to make sex hormones at an earlier time. In other cases, signs of puberty occurearly because of abnormalities in the ovaries, testes or adrenal glands. Tests are done to learn if the cause of precocious
puberty is in the brain or in another part of the body.
What screening is recommended?
All childhood cancer survivors should have a yearly comprehensive health check-up including measurement of height
and weight, and evaluation of pubertal progress. If there are signs of accelerated growth or precocious puberty, yourhealthcare provider may order a blood test to check sex hormones produced in the brain (FSH—follicle stimulating
hormone; LH—luteinizing hormone), testes (testosterone) or ovaries (estradiol) as well as possibly order an x-ray thatmeasures the developmental age or maturation of bone (bone age). Your healthcare provider should refer you to an
endocrinologist (hormone specialist) for further evaluation and treatment.
How is precocious puberty treated?
Endocrinologists may use medications to temporarily stop puberty and to decrease the rate of bone maturation. It isalso important to evaluate and manage the psychological effects of beginning puberty too early. Although children withprecocious puberty may have a mature physical appearance, their thoughts, emotions, and behaviors may still be that of
their actual (chronological) age.
Written by Debra A. Kent, RN, MSN, CPNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Reviewed by Lillian R. Meacham, Daniel Smith, DNP, FNP; Christine Yun MSN, PNP, CPON®; and Kayla L. Foster, MD, MPH.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
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Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health Links
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