Table 2.
Peripheral endocrinopathies.
| Function | Complication | Therapy-related risks | Relationship to time, dose to gland, or organ when applicable | Evaluation/labs | Intervention |
|---|---|---|---|---|---|
| Thyroid | Primary hypothyroidism | Neck irradiation | Risk increases with dose and time after exposure | TSH, FT4 | Levothyroxine |
| I131 labeled agents | MIBG for neuroblastoma | ||||
| Hyperthyroidism | Neck irradiation | Doses ≥35 Gy | TSH, FT4, T3 | Dependent on clinical course | |
| Auto-immune hypothyroidism | HSCT | Transfer of auto-immunity from donor | TSH, FT4 | Levothyroxine | |
| Thyroid neoplasms | Neck irradiation | Doses 20–29 Gy | Yearly palpation of neck | Per etiology | |
| Age <10 at exposure | Thyroid US | ||||
| Females at higher risk | US guided FNAB | ||||
| Gonadal disorders male | Leydig cell dysfunction | Testicular irradiation | Doses ≥24 Gy | AM LH, FSH, testosterone | Replacement therapy with testosterone |
| Alkylating agents | Generally subclinical | ||||
| Germ cell dysfunction | Testicular irradiation | Possible ≥0.15 Gy | Baseline LH, FSH, inhibin B | Sperm banking | |
| High risk ≥2 Gy | |||||
| Alkylating agents | Cyclophosphamide dose ≥7.5 gram/m2a | Adults: semen analysis | |||
| MOPP ≥3 cycles | |||||
| Busulfan ≥600 mg/m2a | |||||
| Ifosfamide ≥60 g/m2a | |||||
| Any alkylating agent in combination with radiotherapy to the testes | |||||
| Gonadal disorders female | Ovarian failure | Abdominopelvic irradiation | Acute ovarian failure doses ≥20 Gy | Baseline LH, FSH, estradiol | Induction of puberty with estradiol Hormone replacement therapy Mature oocyte cryopreservation |
| Premature menopause/infertility at lower doses | |||||
| Higher risk at older age | Pubertal females-AMH | ||||
| Alkylating agents | Higher risk at older age | ||||
| Bone health | Osteoporosis | Radiotherapy | TBI | BMD studies | Per etiology |
| Glucocorticoids, methotrexate | Associated hormone deficiencies Nutritional/lifestyle causes | 25 Hydroxy-Vitamin D levels | |||
| Sex Steroids | |||||
| Metabolic | Obesity overweight Insulin resistance Metabolic syndrome Diabetes mellitus | Surgery | Hypothalamic injury/central obesity | Waist to Hip Ratio | Lifestyle modifications – diet, physical activity |
| Radiotherapy | Cranial radiotherapy abdominal radiation TBI | Fasting: glucose, lipids, insulin, HbA1c | Per etiology | ||
| Oral glucose tolerance if fasting test abnormal | |||||
TBI, total-body irradiation; TSH, thyroid stimulating hormone; AM, morning sample; LH, luteinizing hormone; FSH, follicle-stimulating hormone; FNAB, ultrasound guided fine needle; aspiration biopsy; TKI, tyrosine kinase inhibitors; AMH, anti-Mullerian hormone; BMD, bone mineral density.
aCumulative dose; source: long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers – Version 3.0-Oct 2008. Children’s Oncology Group – www.survivorshipguidelines.org.