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

Central Adrenal Insufficiency after Cancer Treatment
Some people who were treated for cancer during childhood may develop endocrine (hormone) problems because 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 regulates
many body functions including growth, puberty, energy level,urine production, and stress response. Glands of the endocrinesystem 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.

ThyroidPancreas
Adrenal glands

Ovaries

What are hormones?

TestesHormones are chemical messengers that carry informationfrom the endocrine glands through the bloodstream to thebody’s cells. 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 central adrenal insufficiency?
Central adrenal insufficiency is caused by a deficiency of the pituitary hormone known as adrenocorticotropic hormone(ACTH). The adrenal glands (located on top of the kidneys) are stimulated by ACTH to produce a hormone known ascortisol. If the pituitary gland doesn’t make enough ACTH, then cortisol will not be made by the adrenal gland. Cortisol
is important for health because it helps to keep the blood sugar at a normal level and helps the body deal with physicalstress, such as fevers or injuries.
What are the risk factors for central adrenal insufficiency?
•Radiation to the brain, especially in higher doses (30 Gy or 3000 cGy/rads or higher)•

Surgical removal of the pituitary gland

What are the symptoms of central adrenal insufficiency?
Under normal circumstances, there may be no symptoms at all, or there may be mild symptoms, such as fatigue,
weakness, poor appetite, or dizziness. However, under stressful circumstances, such as fever, infection, surgery, orinjury, symptoms may become severe, and may include vomiting, diarrhea, low blood sugar, low blood pressure, anddehydration.
What screening is recommended?
People who had radiation in a dose of 30 Gy (3000 cGy/rads) or higher to the central area of the brain (hypothalamicpituitary axis) should have a yearly blood test to check the cortisol level or yearly evaluation by an endocrinologist(hormone specialist). Anyone who is having symptoms suggestive of central adrenal insufficiency should also have anevaluation by an endocrinologist.
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Healthy living after treatment of childhood, adolescent, and young adult cancer

How is central adrenal insufficiency treated?
Central adrenal insufficiency is treated with hydrocortisone, a medication that is given by mouth every day on a regularschedule. In times of increased stress, such as illness or surgery, the dose of hydrocortisone is increased, also known
as stress dosing, and can be administered by injection if necessary. If you have central adrenal insufficiency, you shouldwear a medical alert bracelet so that in case of an accident or sudden illness, emergency medical workers will be awareof your special health needs.
Written by Debra A. Kent, RN, MSN, CPNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and Wendy Landier, PhD,CPNP, Children’s Hospital of Alabama, Birmingham, AL.
Reviewed by Angela Yarbrough DNP, APRN, FNP-BC, CPON®; 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
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
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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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