Version June 2024
| Potential late effect | Anatomical location of injury | Cytotoxic therapy | Basic screening tests and frequency* |
| GH deficiency | Hypothalamic-pituitary axis | Radiation to the hypothalamic-pituitary axis (≥18 Gy) Surgery impacting the hypothalamic-pituitary area | Plot height on normative growth curves every 6 months through puberty GH stimulation testing, if indicated |
| LH/FSH deficiency | Hypothalamic-pituitary axis | Radiation to the hypothalamic-pituitary axis (>30 to 40 Gy) Surgery impacting the hypothalamic-pituitary area | Physical examination with Tanner staging Baseline measurements – In males, LH, FSH, and testosterone at 14 years; in females, LH, FSH, and estradiol at 13 years Repeated measurements when clinically indicated |
| Precocious puberty | Hypothalamic-pituitary axis | Radiation to the hypothalamic-pituitary axis (≥18 Gy) | Physical examination with Tanner staging every 6 months |
| Central hypothyroidism (TRH/TSH deficiency) | Hypothalamic-pituitary axis | Radiation to the hypothalamic-pituitary axis (>30 to 40 Gy) Surgery impacting the hypothalamic-pituitary area | Annual measurement of free T4 Consider more frequent screening during periods of rapid growth |
| Central hypoadrenalism (ACTH deficiency) | Hypothalamic-pituitary axis | Radiation to the hypothalamic-pituitary axis (>30 to 40 Gy) Chronic glucocorticoid therapy (transient deficiency) | Annual measurement of 8 AM cortisol level or appropriate stimulation testing |
| Arginine vasopressin deficiency¶ | Hypothalamic-pituitary axis | Surgery impacting the hypothalamic-pituitary area Infiltrative tumors in the hypothalamic-pituitary area | If clinically indicated, measurement of serum and urine sodium and osmolality Water deprivation testing, if indicated |
| Thyroid gland dysfunction | Thyroid gland | Radiation impacting the thyroid, including I-131 Drug therapy with tyrosine kinase inhibitors | Annual measurement of TSH and free T4 (and T3 if hyperthyroidism is suspected) Consider more frequent screening during periods of rapid growth |
| Gonadal dysfunction (female) | Ovaries | Radiation to the gonads Side effect of drug therapy due to:
| Physical examination with Tanner staging Baseline measurement of FSH and estradiol at 13 years of age and then as clinically indicated |
| Gonadal dysfunction (male) | Testes | Radiation to the gonads Side effect of drug therapy due to:
| Physical examination with Tanner staging For sexually mature males who desire additional information about fertility, semen analysis (optimal) or measurement of FSH and inhibin B (for those unwilling to provide semen sample) |
| Skeletal damage | Spine | Radiation to the spine | Annual measurement of sitting height |
| Impaired bone mineral density | Other | Cranial radiation Side effect of drug therapy due to glucocorticoids | Baseline DXA scan or other method (eg, quantitative computed tomography) at entry into long-term follow-up; repeat as clinically indicated |
| Diabetes mellitus | Other | Abdominal or total body irradiation | Biannual measurement of plasma glucose and/or hemoglobin A1c |
GH: growth hormone; LH: luteinizing hormone; FSH: follicle-stimulating hormone; TRH: thyrotropin-releasing hormone; TSH: thyroid-stimulating hormone; T4: thyroxine; ACTH: adrenocorticotropic hormone; I-131: iodine-131; DXA: dual-energy x-ray absorptiometry; T3: triiodothyronine.
* All screening testing recommendations adapted from the Children's Oncology Group Long-Term Follow-Up Guidelines, which are available at www.survivorshipguidelines.org.
2 ¶ Arginine vasopressin (antidiuretic hormone) deficiency was previously termed central diabetes insipidus.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
