Childhood cancer survivors can be at risk for developing the following endocrine late effects:
- Growth Hormone Deficiency
- Hypothyroidism
- Hyperthyroidism
- Thyroid Nodules
- Adrenal Insufficiency
- Hyperprolactinemia
- Decreased Bone Mineral Density
See Ovary/Testis Quick Fact for the following late effects:
- Precocious Puberty
- Gonadal Failure
- Infertility
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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
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Chemotherapy
Table 1
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Growth Hormone Deficiency
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Hypo-thyroidism
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Hyper-thyroidism
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Thyroid Nodules
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Adrenal Insufficiency
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Hyper-prolactinemia
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Decreased bone mineral density
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Alkylating Agents
Busulfan
Carmustine
BCNU
Chlorambucil Cyclophosphamide
Cytoxan
Ifosphamide
Lomustine
CCNU
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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Heavy Metals
Carboplatin
Cisplatin
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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X
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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Chemotherapy
Table 2
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Growth Hormone Deficiency
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Hypo-thyroidism
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Hyper-thyroidism
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Thyroid Nodules
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Adrenal Insufficiency
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Hyper-prolactinemia
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Decreased bone mineral density
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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X
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Enzymes
Asparaginase
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Plant alkaloids
Vincristine
Vinblastine
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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Radiation
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Growth Hormone Deficiency
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Hypo-thyroidism
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Hyper-thyroidism
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Thyroid Nodules
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Adrenal Insufficiency
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Hyper-prolactinemia
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Decreased bone mineral density
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All Radiation
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TBI
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X
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X
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X
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Head/Brain
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X
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> 40 Gy
Include TBI in total dose calculation
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> 40 Gy
Include TBI in total dose calculation
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X
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> 40 Gy
Include TBI in total dose calculation
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> 40 Gy
Include TBI in total dose calculation
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Neck
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X
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X
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X
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Thorax
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X
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X
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X
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Abdomen
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Pelvis
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Extremity
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Surgery/Other
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Growth Hormone Deficiency
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Hypo-thyroidism
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Hyper-thyroidism
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Thyroid Nodules
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Adrenal Insufficiency
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Hyper-prolactinemia
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Decreased bone mineral density
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Thyroidectomy
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X
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Radioiodine Therapy
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X
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Systemic
MIBG in therapeutic doses
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X
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Hematopoietic
Stem Cell Transplant
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Growth Hormone Deficiency
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Hypo-thyroidism
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Hyper-thyroidism
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Thyroid Nodules
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Adrenal Insufficiency
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Hyper-prolactinemia
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Decreased bone mineral density
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Hematopoietic
Stem Cell Transplant
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X
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Hematopoietic Stem Cell Transplant with ANY history of chronic Graft vs. Host Disease (GVHD)
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