Childhood cancer survivors can be at risk for developing the following endocrine late effects:

Growth Hormone Deficiency

Hypothyroidism
Central
Primary

Hyperthyroidism

Thyroid Nodules

Adrenal Insufficiency

Hyperprolactinemia

Decreased Bone Mineral Density

Diabetes Insipidus

Diabetes Mellitus

See Ovary/Testis Quick Fact for the following late effects:

Precocious Puberty

Gonadal Failure

Infertility

If your patient does not have a Survivor Healthcare Plan (SHP), please refer him/her to the appropriate survivor clinic.

Important factors in determining risk for endocrine late effects:

Age of patient at time of treatment
Total dose of radiation
Surgery or tumor in hypothalmic area
Time since treatment
Gender
Ethnicity
Body Mass Index
Smoking

Chemotherapy Table 1	Growth Hormone Deficiency	Hypo-thyroidism	Hyper-thyroidism	Thyroid Nodules	Adrenal Insufficiency	Hyper-prolactinemia	Decreased bone mineral density	Diabetes Insipidus	Diabetes Mellitus
Alkylating Agents BCNU Busulfan CCNU Chlorambucil Cyclophosphamide Cytoxan Ifosphamide Mechlorethamine Melphalan Procarbazine Thiotepa Dacarbazine DTIC Temozolomide
Heavy Metals Carboplatin Cisplatin
Antimetabolites Cytarabine Ara-C Mercaptopurine 6MP Thioguanine 6TG Methotrexate							X
Anthracycline antibiotics Daunorubicin Doxorubicin Adriamycin Epirubicin Idarubicin Mitoxantrone

Chemotherapy Table 2	Growth Hormone Deficiency	Hypo-thyroidism	Hyper-thyroidism	Thyroid Nodules	Adrenal Insufficiency	Hyper-prolactinemia	Decreased bone mineral density	Diabetes Insipidus	Diabetes Mellitus
Anti-tumor antibiotics Bleomycin Dactinomycin
Corticosteroids Dexamethasone Decadron Prednisone							X
Enzymes Asparaginase
Plant alkaloids Vincristine Vinblastine
Epipodophyllotoxins Etoposide VP16 Teniposide VM26

Radiation	Growth Hormone Deficiency	Hypo-thyroidism	Hyper-thyroidism	Thyroid Nodules	Adrenal Insufficiency	Hyper-prolactinemia	Decreased bone mineral density	Diabetes Insipidus	Diabetes Mellitus
All Radiation
TBI	X	X		X
Head/Brain	X	> 40 Gy Include TBI in total dose calculation		X	> 30 Gy Include TBI in total dose calculation	> 40 Gy Include TBI in total dose calculation
Neck		X	X	X
Thorax		X	X	X
Abdomen									X
Pelvis
Extremity

Surgery/Other	Growth Hormone Deficiency	Hypo-thyroidism	Hyper-thyroidism	Thyroid Nodules	Adrenal Insufficiency	Hyper-prolactinemia	Decreased bone mineral density	Diabetes Insipidus	Diabetes Mellitus
Thyroidectomy		X
Neurosurgery - Brain								X
Radioiodine Therapy		X
Systemic MIBG in therapeutic doses		X

Hematopoietic Stem Cell Transplant	Growth Hormone Deficiency	Hypo-thyroidism	Hyper-thyroidism	Thyroid Nodules	Adrenal Insufficiency	Hyper-prolactinemia	Decreased bone mineral density	Diabetes Insipidus	Diabetes Mellitus
Hematopoietic Stem Cell Transplant							X
Hematopoietic Stem Cell Transplant with ANY history of chronic Graft vs. Host Disease (GVHD)

For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-term Follow-up Guidelines.

Health Links- Teaching Handouts from The Children's Oncology Group

Visit www.survivorshipguidelines.org to find many of the Health Links translated into other languages.

References:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 5/6/2019 7:20:55 PM

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