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Growth Hormone Deficiency

Some survivors of childhood cancer may develop growth problems as a result of cancer treatments.

Growth problems can happen because certain glands in the endocrine system do not produce enough hormones. 

The endocrine system is a group of glands that controls body functions including growth, energy, and puberty. These glands release hormones into the bloodstream that carry messages to cells throughout the body. These hormones work together to make sure the body functions correctly.

Damage to endocrine glands such as the pituitary, which makes the growth hormone, can slow a child’s growth and affect bones and height. Synthetic (man-made) growth hormone can treat the problem. The pituitary gland, located in the brain, is sometimes called “the master gland” because it controls other glands such as the thyroid, adrenals, ovaries (in females), and testes (in males).

Childhood cancer survivors may develop growth problems as a result of certain cancer treatments. In this image, cancer center staff measures a survivor’s height.

Childhood cancer survivors may develop growth problems as a result of certain cancer treatments.

Cancer Treatments That Can Cause Growth Hormone Deficiency

  • Cancer treatment before reaching adult height, especially in very young patients.
  • Radiation to the:
    • Brain (cranial)
    • Eye or eye socket (orbit)
    • Ear or midfacial area behind the cheekbones (infratemporal region) 
    • Area above the roof of the mouth (nasopharynx
    • Total body irradiation (TBI) 
  • Surgery to the brain, particularly the central (suprasellar) region where the pituitary gland can be found.
  • Tumor growth within the central (suprasellar) region causing direct damage to the pituitary gland

Signs and symptoms

In children, the most obvious sign of deficiency is the slowing of growth or height.

Other signs include:

  • Growing more slowly than normal for age (crossing lines on the growth chart)
  • Smaller and younger-looking than children of the same age but with normal body proportions

Adults with growth and hormone deficiency may experience:

  • Thinning of the bones
  • Decreased muscle strength
  • Increased body fat, especially around the abdomen
  • Abnormal blood levels of lipids and cholesterol

What Survivors Can Do

Know Your Risk and Monitor Your Health

Ask your oncologist about your risks of developing late effects.

Inform your primary health care provider about your risks. Share a copy of your Survivorship Care Plan, which includes a treatment summary. 

Have a yearly physical examination. The exam should include measurement of height and weight and assessment of puberty development and nutritional status.

Patients at risk for growth hormone deficiency should have this screening every six months until growth is completed.

If patients have signs and symptoms of poor growth, the health care provider may:

  • Order an X-ray on the wrist to assess the maturity of the skeleton "bone age"
  • Check for possible causes of growth problems, such as low thyroid function.
  • Refer the survivor to a doctor that specializes in hormone problems (endocrinologist).

Treatment

Treatment usually involves synthetic growth hormone over several years. The endocrinologist should provide information about how much growth is possible.

Childhood cancer patients at risk for developing growth hormone deficiency should have an exam that includes measurement of height and weight every six months until growth is completed. In this image, cancer center staff measures a survivor’s weight.

Childhood cancer patients at risk for developing growth hormone deficiency should have an exam that includes measurement of height and weight every six months until growth is completed.


Reviewed: June 2018

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