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

Growth Hormone Deficiency 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 regulates 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
Pituitary glandand pituitary are sometimes called the “master glands”
Hypothalamus
because they control many of the other glands in theThyroid
endocrine system. Unfortunately, some treatments given
for childhood cancer can damage the endocrine system,
resulting in a variety of problems.
Pancreas

What are hormones?

Adrenal glands

Hormones are chemical messengers that carryinformation from the endocrine glands through thebloodstream to the body’s cells. The endocrine system
makes many hormones (such as growth hormone), sexhormones, adrenal and thyroid hormones) that work
together to maintain specific bodily functions.

Ovaries

TestesWhat is growth hormone deficiency?
Growth hormone (GH) is made by the pituitary gland. In order for children to grow to their full height potential, theyneed adequate amounts of GH. GH works with thyroid hormone, exercise, proper nutrition, and rest to help children andteenagers grow. GH also helps maintain normal blood sugar levels and is needed for the normal development of teeth.
In addition to helping with bone growth, GH affects how well the heart and blood vessels work, how the body uses fat,makes muscle, and strengthens bones, and generally influences overall health throughout life. In healthy people, GH
production continues into adulthood. Adults need small amounts of GH to maintain proper amounts of fat, muscle andbone. GH may also play a role in regulating mood and emotion.
Cancer treatments, such as radiation or surgery to structures in the head or brain, may cause malfunction of the glands
that control growth. As a result, the pituitary gland may not make enough GH, resulting in GH deficiency. GH deficiency
can also occur in people who have never had cancer treatment.
What are the signs and symptoms of growth hormone deficiency?
Slowing of growth (height) is one of the most obvious signs of GH deficiency in children. A GH deficient child usually
grows less than 2 inches per year. Children with GH deficiency are smaller and tend to look younger than children theirsame age, but they usually have normal body proportions.
Adults who have GH deficiency may have a variety of different physical symptoms, such as thinning of the bones,decreased muscle strength, increased body fat, or high blood cholesterol levels. Adults may also have symptoms suchas feeling tired, anxious, irritable, gloomy, unmotivated, or having a decreased interest in sex.

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

What are the risk factors for growth hormone deficiency?
Risk factors related to treatment for cancer during childhood include:• Cancer treatment before reaching adult height, especially in very young patients• Radiation to:– Head/brain– Total body irradiation (TBI)• Surgery to the brain, especially the central region of the brain where the pituitary gland is located (suprasellarregion)
What screening is recommended?
All childhood cancer survivors should have a yearly comprehensive health check-up including measurement of height
and weight, assessment of pubertal status, nutritional status, and overall well-being. For patients with the risk factors
listed above, this screening should be done every 6 months until growth is completed. If there are signs of poor
growth, an x-ray of the wrist (bone age x-ray) should be done. Other possible causes of growth problems, such as low
thyroid function, should also be checked.
If GH deficiency is suspected, your healthcare provider should refer you to an endocrinologist (hormone specialist) for
further evaluation and treatment.
How is growth hormone deficiency treated?
Endocrinologists may suggest treatment options that involve supplementing or replacing GH that your pituitary glandis not making on its own with synthetic GH given by injection. GH is usually given for several years, until the person
reaches an acceptable adult height or the greatest possible height. Your endocrinologist can give you information about
how much growth is possible on GH therapy. Treatment options for GH deficiency that persists into adulthood should be
discussed on an individual basis with your endocrinologist.
Written by: Debra A. Kent, RN, MSN, CPNP, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Reviewed by Lillian R. Meacham, MD; 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 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 HealthLinks 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.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate
criteria for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable
alternative follow-up procedures. The Informational Content is provided as a courtesy, but not intended as a sole source of guidance in the evaluation of childhood cancer survivors. The
Children’s Oncology Group recognizes that specific patient care decisions are the prerogative of the patient, family, and healthcare provider.

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