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

Hypopituitarism 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.
What is the endocrine system?
The endocrine system is a group of glands that regulate many
body functions including growth, puberty, energy level, urine
production, and stress response. Glands of the endocrine
system include the pituitary, hypothalamus, thyroid, pancreas,adrenals, 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.
What are hormones?

Pituitary gland
Hypothalamus
Thyroid

Pancreas
Adrenal glands

Ovaries

TestesHormones are chemical messengers that carry informationfrom the endocrine glands through the bloodstream to the body’s cells. The endocrine system makes many hormones(such as growth hormone, sex hormones, adrenal and thyroid hormones) that work together to maintain specific bodilyfunctions.
What is hypopituitarism?
Hypopituitarism is the decrease or lack of one or more of the pituitary hormones. The lack of three or more of thepituitary hormones is referred to as panhypopituitarism.
Pituitary hormones include:• Growth hormone (GH)—stimulates the growth of bone and other body tissues, and also affects how the bodyuses fat, makes muscle, strengthens bones, and generally influences overall health throughout life• Adrenocorticotropic hormone (ACTH)—stimulates the adrenal gland to produce cortisol• Thyroid stimulating hormone (TSH)—stimulates the thyroid gland to produce thyroid hormones• Reproductive hormones (gonadotropins), including luteinizing hormone (LH) and follicle stimulating
hormone (FSH)—stimulate the testes and ovaries to make sex hormones• Antidiuretic hormone (ADH)—helps to control the balance of water in the body by controlling urine output•

Prolactin—controls milk production during breastfeeding

What are risk factors for hypopituitarism?
Risk factors related to childhood cancer treatment include:• Radiation to the brain, especially in doses of 30 Gy (3000 cGy/rads) or higher• Surgical removal of the pituitary gland• Damage to the hypothalamus or pituitary gland, which can occur during brain surgery, or can be caused by atumor in or near the pituitary or hypothalamus• Infections
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Healthy living after treatment of childhood, adolescent, and young adult cancer•

Severe head trauma•

Lack of development of the pituitary from birth

What are the symptoms of hypopituitarism?
The symptoms depend on the specific hormones that are lacking. One or more of the following hormones may beaffected:•Growth hormone (GH) deficiency - GH affects the growth of body tissues and bone as well as fat,muscle, and sugar metabolism. For more information about growth hormone problems, see the related Health
Link: Growth Hormone Deficiency after Cancer Treatment•

Adrenocorticotropic hormone (ACTH) deficiency - The adrenal glands (located on top of the kidneys)
are stimulated by ACTH to produce cortisol. If the pituitary gland doesn’t make enough ACTH, then cortisol will
not be made. Cortisol helps keep the body’s blood sugar at a normal level and helps the body deal with physicalstress, such as fever or injury. For more information about ACTH deficiency, see the related Health Link: Central
Adrenal Insufficiency after Cancer Treatment•Thyroid Stimulating Hormone (TSH) deficiency - TSH stimulates the thyroid gland to releasethyroxine, which is important for brain development, growth, and metabolism. People with too little thyroxine
may develop the following symptoms: tiredness, sleeping too much, weight gain, slow growth, poor appetite,cold intolerance, dry skin, constipation, or hair that is dry, coarse, and thin. For more information about thyroidproblems, see the related Health Link: Thyroid Disease after Cancer Treatment•

Gonadotropin (FSH, LH) deficiency - LH and FSH control the production of sex hormones. LH and FSH
stimulate the testicles to make testosterone, and the ovaries to make estrogen and progesterone, resulting
in development of sexual characteristics during puberty. If the body doesn’t have enough LH and FSH duringpuberty, there can be problems with pubertal development. For more information, see the related Health Links:
Testicular and Reproductive Health after Cancer Treatment and Ovarian and Reproductive Health after Cancer
Treatment•Antidiuretic Hormone (ADH) deficiency - ADH (also known as “vasopressin”) is a hormone producedin the hypothalamus and stored in the pituitary gland. When the amount of water in the body is low, the pituitary
gland releases ADH, sending a message to the kidneys to conserve water. This slows down the productionof urine. When there is not enough ADH, too much urine will be produced, resulting in a condition known asdiabetes insipidus. Symptoms of diabetes insipidus include excessive thirst and frequent urination.

What screening is recommended?
All cancer survivors should have a yearly comprehensive health check-up including measurement of height andweight, assessment of their progression through puberty, and assessment of overall well-being. If hypopituitarism issuspected, your healthcare provider should refer you to an endocrinologist (hormone specialist) for further evaluationand treatment.

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

Written by: Debra A. Kent, RN, MSN, CPNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Reviewed by Lillian R. Meacham, MD; Shekinah Andrews, 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 youngadulthood.
Disclaimer and Notice of Proprietary Rights
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 were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding amedical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
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