| GH deficiency |
Radiation: >18 Gy to H-P axis |
Falling off of growth curve, inadequate growth velocity, inadequate pubertal growth spurt |
Annual stadiometer height (every 6 months at age 9–12 years), growth curve, bone age at 9 years, then every year to puberty (insulin stimulation test and pulsatile GH analysis) |
GH therapy, delay puberty with gonadotropin releasing hormone (GnRH) agonist |
|
Surgery: Tumor in region of H-P axis |
| Adrenocorticotropic hormone deficiency |
Radiation: >40 Gy to H-P axis |
Muscular weakness, anorexia, nausea, weight loss, dehydration, hypotension, abdominal pain, increased pigmentation (skin, buccal mucosa) |
Cortisol (a.m.) baseline, prn symptoms (insulin–hypoglycemia; metapyrone stimulation tests) |
Hydrocortisone |
|
Surgery: Tumor in region of H-P axis |
| Thyrotropin-releasing hormone deficiency |
Radiation: >40 Gy H-P axis |
Hoarseness, fatigue, weight gain, dry skin, cold intolerance, dry brittle hair, alopecia, constipation, lethargy, poor linear growth, menstrual irregularities, pubertal delay, bradycardia, hypotension |
Free T4, T3, TSH baseline, every 3–5 years |
Hormone replacement with T4, anticipatory guidance regarding symptoms of hypothyroidism |
|
Surgery: Tumor in region of H-P axis |
| Precocious puberty (especially females) |
Radiation: >20 Gy to H-P axis |
Early growth spurt, false catch-up, premature sexual maturation; female: breast development and pubic hair before 8 years and menses before 9 years; male: testicular/penile growth and pubic hair before 9–9.5 years |
Height, growth curve every year, bone age every 2 years until mature, (LH, follicle- stimulating hormone [FSH], estradiol or testosterone)(pelvic ultrasound, GnRH-stimulation testing) |
GnRH agonist |
|
Surgery: Tumor in region of H-P axis |
| Gonadotropin deficiency: |
| Male |
Radiation: >40 Gy to hypothalamic region |
Delayed/ arrested/absent pubertal development:
lack of or diminished
pubic and axillary hair, penile and testicular enlargement, voice change, body odor, acne;
testicular atrophy (softer and smaller);
failure to impregnate
|
Tanner stage, LH, FSH, estradiol every 3–5 years, (GnRH testing) |
Anticipatory guidance regarding symptoms of estrogen deficiency, hormone replacement, early intervention may prevent osteoporosis, and atherosclerosis |
|
Surgery: Tumor in region of hypothalamus |
| Female |
Radiation: >40 Gy to hypothalamic region |
Delayed/ arrested/ absent pubertal development including: breasts,
female escutcheon, female habitus, vaginal estrogen effect, body odor, acne; changes in duration, frequency, and character of menstruation (less cramping) estrogen deficiency: hot flashes, vaginal dryness, dyspareunia, low libido; infertility (if not on birth control pills) |
Tanner stage, LH, FSH, estradiol every 3–5 years, GnRH-stimulation tests |
Anticipatory guidance regarding symptoms of estrogen deficiency, hormone replacement, early intervention may prevent osteoporosis, and atherosclerosis |
|
Surgery: Tumor in region of hypothalamus |
| Hyper-prolactinemia |
Radiation: >40 Gy H-P axis |
Female: menstrual irregularities, loss of libido, infertility, galactorrhea, hot flashes, osteopenia; male: loss of libido, impotence, infertility |
Prolactin-level baseline, then as needed for symptoms |
Dopamine agonist (bromocriptine) |
|
Surgery: Tumor in region of hypothalamus |
| Metabolic syndrome |
Chemotherapy: Steroids |
Obesity, hypertension, hyperlipidemia, hyperglycemia, insulin resistance with hyperinsulinemias |
Fasting lipids, glucose, insulin levels, body mass index (BMI) evaluation |
Refer to endocrinology |
|
Radiation: Questionable ≥18 Gy (dose not well established) |
