Table 2.
Risk-Based Screening Recommendations for Potential Endocrine and Reproductive Organ Toxicity Associated With Treatment for Childhood Cancer
| Affected Organ/Tissues | Treatment | Potential Late Effect | Risk-Based Screening |
|---|---|---|---|
| Hypothalamic-pituitary axis | Radiation impacting neuroendocrine axis | Growth hormone deficiency overweight/obesity | Tanner staging every 6 months until sexually mature; height, weight, BMI every 6 months until growth is completed, then yearly; fasting blood glucose and lipid profile every 2 years and more frequently if indicated; and consider evaluation for other co-morbid conditions including dyslipidemia, hypertension, glucose intolerance, diabetes mellitus, hyperinsulinism, and insulin resistance |
| Thyroid gland | Radiation impacting thyroid gland | Hypothyroidism; hyperthyroidism; thyroid nodules | Thyroid palpation yearly; consider ultrasound/fine-needle aspirate for evaluation of palpable nodules |
| Female reproductive organs | Radiation impacting ovaries; alkylating agents* | Gonadal dysfunction (ovarian); delayed/arrested puberty; premature menopause; infertility | Tanner staging yearly; FSH, LH, estradiol baseline at age 13 years, and as clinically indicated in patients with delayed puberty, irregular menses, primary or secondary amenorrhea, and/or clinical signs and symptoms of estrogen deficiency; consider evaluation for conditions exacerbated by hypogonadism (eg, osteopenia/osteoporosis) |
| Male reproductive organs | Radiation impacting testes; alkylating agents* | Gonadal dysfunction (testicular); germ cell failure (oligospermia, azoospermia, infertility); leydig cell dysfunction; delayed/arrested puberty (hypogonadism) | Testicular volume by Prader orchidometry yearly until sexually mature; FSH, LH, testosterone baseline at age 14 years, and as clinically indicated in patients with delayed puberty or clinical signs and symptoms of testosterone deficiency; consider evaluation for conditions exacerbated by hypogonadism (eg, low bone mineral density) |
| Skeleton | Corticosteroids, methotrexate | Low bone mineral density | Bone density evaluation (DXA or quantitative CT) baseline at entry into long-term follow-up, then repeat as clinically indicated) |
Abbreviations: BMI, body mass index; FSH, follicle-stimulating hormone; LH, luteinizing hormone; DXA, dual energy x-ray absorptiometry; CT, computed tomography.
*
Includes classical (busulfan, carmustine, chlorambucil, cyclophosphamide, ifosfamide, mechlorethamine, melphalan, procarbazine, thiotepa), heavy metal (carboplatin, cisplatin), and nonclassical (dacarbazine, temozolomide) alkylating agents.