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Some people who were treated for cancer during childhood may develop endocrine (hormone) problems as a result of changes in the function of a complex system of glands known as the endocrine system.
The endocrine system is a group of glands that regulate many body functions including growth, puberty, energy level, urine production, and stress response. Glands of the endocrine system include the pituitary, hypothalamus, thyroid, adrenals, pancreas, ovaries (in females), and testes (in males). The hypothalamus and pituitary are sometimes called the "master glands" because they control many other glands in the endocrine system. Unfortunately, some treatments given for childhood cancer can damage the endocrine system, resulting in a variety of problems.
Growth hormone (GH) is made by the pituitary gland. In order for children to grow to their full height potential, they need adequate amounts of GH. GH works in combination with thyroid hormone, exercise, proper nutrition, and rest to help children and teenagers grow. GH also helps maintain blood sugar levels and is necessary for the normal development of teeth. In addition to helping with bone growth, GH affects how well the heart and blood vessels work; how the body uses fat, makes muscle, and strengthens bones; and overall health throughout life.
A noticeable slowing of growth (height) is one of the most obvious signs of GH deficiency in children. A GH deficient child usually grows less than 2 inches per year. Children with GH deficiency are smaller and tend to look younger than their peers, but they usually have normal body proportions.
All children's cancer survivors should have a yearly physical examination including measurement of height and weight, and assessment of pubertal status, nutritional status, and overall well-being. For patients with the risk factors listed above, this screening should be done every 6 months until growth is completed.
If GH deficiency is detected, the endocrinologist will suggest treatment options. Usually, this involves supplementing or replacing the GH that the pituitary gland is not making on its own. Called synthetic GH, this supplement is given by injection. GH is usually given for several years, until the person reaches acceptable adult height or maximum potential. The endocrinologist can provide a realistic expectation about growth potential. Treatment options for GH deficiency that persists into adulthood should be discussed with the endocrinologist.