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Endocrine Society Issues Guideline to Address the Risk of Endocrine Disorders Among Survivors of Childhood Cancers

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Key Points

  • Almost 50% of survivors of childhood cancers will develop an endocrine disorder over their lifetime.
  • The Endocrine Society’s Clinical Practice Guideline includes the long-term screening of childhood cancer survivors who underwent radiation therapy to key endocrine organs and calls for the screening of growth disorders, pituitary hormone deficiencies, and early puberty.
  • The guideline stresses the importance of lifelong screening in this population for earlier detection of endocrine and growth disorders and the achievement of optimal patient care.

To address a growing risk of endocrine disorders among childhood cancer survivors, the Endocrine Society has published the “Hypothalamic-Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline,” advising health-care providers on the long-term screening of survivors of childhood cancers at risk for treatment-related problems, including growth disorders, pituitary hormone deficiencies, and early puberty, and how to diagnose and manage these conditions. The guideline by Sklar et al is published in The Journal of Clinical Endocrinology & Metabolism.

Due to improvements in childhood cancer treatment and supportive care over the past several decades, the 5-year survival rate for patients diagnosed with childhood cancers is more than 80%. However, because of their disease and treatment, especially radiation exposure to endocrine organs, these survivors are at an increased risk for developing serious health conditions, including growth disorders. Recent data show that between 40% and 50% of childhood cancer survivors will develop an endocrine disorder during their lifetime, increasing the importance of lifelong surveillance in this population. 

Clinical Practice Recommendations

An Endocrine Society–appointed guideline-writing committee consisting of six medical experts and a methodologist formulated the clinical practice guideline recommendations in the diagnosis, treatment, and management of endocrine-related conditions. The recommendations include the long-term screening of childhood cancer survivors who underwent radiation therapy to key endocrine organs, including the hypothalamus, pituitary, thyroid, and gonads, and calls for the screening of growth disorders, pituitary hormone deficiencies, and early puberty.

According to the recommendations, if a condition is diagnosed, in most cases, clinicians should treat these survivors with the same approaches as other patients who develop endocrine conditions. The recommendations cover six areas of concern in childhood cancer survivors, including:

  1. Diagnosis and monitoring of short stature/impaired linear growth
  2. Growth hormone deficiency and its treatment
  3. Central precocious puberty
  4. Hypogonadotropic hypogonadism 
  5. Central hypothyroidism/thyroid-stimulating hormone deficiency
  6. Adrenocorticotropic hormone deficiency

“Childhood cancer survivors have a high risk of developing endocrine disorders,” said Charles A. Sklar, MD, a pediatric endocrinologist at Memorial Sloan Kettering Cancer Center, New York, and Chair of the writing committee that developed the guideline. “Our new guideline addresses the growing risk of endocrine disorders among childhood cancer survivors and suggests best practices for managing pituitary and growth disorders commonly found in this population. The guideline stresses the importance of lifelong screening of these survivors for earlier detection and optimal patient care.” 

Dr. Sklar is the corresponding author of the Endocrine Society’s cinical practice guideline. The Endocrine Society provided funding for this guideline.

For full disclosures of the guideline authors, see the Appendix of the clinical practice guideline.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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