The ovary and the testes have two functions: sex hormone production (estradiol and testosterone) and gamete production (oocytes or sperm). Sex hormone production can be impaired after certain cancer treatments. Girls are more likely to have impairment of sex hormone production compared to males. Older females are more vulnerable than younger prepubertal females. Early onset of puberty can also be seen in survivors.
Take Home Points:
- Specific chemotherapies and certain radiation sites may disrupt the production of ovarian/testicular hormones.
- Precocious puberty can result from cranial radiation.
- Hormone therapy and oral contraceptives can mask the signs of hypogonadism and make hormone interpretation difficult.
- There are differences in males and female sensitivity to gonadotoxic exposures.
- Normal timing of the onset of puberty in females is age 8-13 years and in males age 9-14 years.
- When puberty is delayed it can be:
- normal variant – constitutional delay of growth and puberty
- primary hypogonadism due to damage to the ovaries or testes
- central hypogonadism due to damage to the hypothalamus and pituitary
- Precocious puberty can be seen after cranial irradiation.
- Cancer treatments that can lead gonadal dysfunction include:
- Alkylating agent or heavy metal chemotherapy
- Radiation exposure to the ovaries/testes
- Radiation exposure to the hypothalamus
- Tumor or surgery on the hypothalamus, pituitary, ovaries or testes.
- Bone marrow transplant
- Surveillance for cancer treatment related gonadal hormone deficiency includes:
- Assessment of height, weight, BMI and rates of change in percentiles annually
- Tanner Staging annually
- If abnormalities in the timing or tempo of puberty refer to pediatric endocrinology
- Consider LH, FSH, estradiol and AMH in females
- Consider LH, FSH and testosterone in males
- Bone age
Continuing Education Module
Health Links - Teaching Handouts from the Children's Oncology Group