Hypothalamic–Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline Educational Activity

Due to remarkable improvements in childhood cancer treatment and supportive care during the past several decades, 5-year survival rates for childhood cancer currently are >80%. However, by virtue of their disease and its treatments, childhood cancer survivors are at increased risk for a wide range of serious health conditions, including disorders of the endocrine system. Recent data indicate that 40% to 50% of survivors will develop an endocrine disorder during their lifetime. Risk factors for endocrine complications include both host (e.g., age, sex) and treatment factors (e.g., radiation). Radiation exposure to key endocrine organs (e.g., hypothalamus, pituitary, thyroid, and gonads) places cancer survivors at the highest risk of developing an endocrine abnormality over time; these endocrinopathies can develop decades following cancer treatment, underscoring the importance of lifelong surveillance. The following guideline addresses the diagnosis and treatment of hypothalamic–pituitary and growth disorders commonly encountered in childhood cancer survivors.

Within this activity you will assess your knowledge of diagnosis and management for this patient population through case-based vingettes.

Target Audience

This content is for physicians and healthcare professionals seeking to remain up to date on the latest recommendations made by the Society for endocrine treatment of survivors of childhood cancer with hypothalamic-pituitary and growth disorders.

Learning Objectives

  • Diagnose central precocious puberty in male childhood cancer survivors exposed to gonadotoxic therapy.
  • Explain how GH deficiency and central precocious puberty may occur together, making it difficult to interpret linear growth data.
  • Diagnose non–GH-related causes of growth failure such as spinal irradiation.
  • Accurately interpret thyroid function tests in patients at risk for primary and central hypothyroidism.
  • Explain the importance of the synergistic action of GH and sex hormones in the growing adolescent.
  • Explain the risk for exacerbation of the symptoms of adrenal insufficiency in individuals on thyroid replacement and untreated central adrenal insufficiency.

Additional Information

Target Audience: 
Clinical researcher
Nurse/Nurse practitioner
Physician assistant
Allied health professional
Competency Area: 
Medical Knowledge
Topic Area: 
Hormones and Cancer
Level of Outcomes: 
Level 1 (Participation)
Level 2 (Satisfaction)
Level 3A (Learning: Declarative Knowledge (Knows))
Level 3B (Learning: Procedural Knowledge (Knows How))
Activity summary
Available credit: 
  • 0.50 AMA PRA Category 1 Credits
  • 0.50 CME Certificate of Participation
Course opens: 
Course expires: 


Wassim Chemaitilly, MD
Assistant Member and Director, Divison of Endocrinology
St. Jude Children's Research Hospital

Charles A. Sklar, MD (Chair of Task Force and Peer Reviewer)
Director, Long-Term Follow-Up Program
Memorial Sloan-Kettering Cancer Center


As a provider of CME accredited by the Accreditation Council for Continuing Medical Education, the Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous.


The faculty, committee members, and staff who are in position to control the content of this activity are required to disclose to the Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are related to the CME content. Financial relationships are defined by remuneration in any amount from the commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (eg, stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers’ bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent CME planners with relevant financial relationships from planning or delivering content, but rather to provide learners with information that allows them to make their own judgments of whether these financial relationships may have influenced the educational activity with regard to exposition or conclusion. The Endocrine Society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.

The following faculty reported relevant financial relationship(s):

Wassim Chemaitilly, MD was a consultant for Novo Nordisk and Pfizer.

Charles Sklar, MD received a concerence honorarium from Sandoz.

The medical editor for this program, Abbie L. Young, MS, CGC, ELS(D), reported no relevant financial relationships.

The Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.


The information presented in this activity represents the opinion of the faculty and is not necessarily the official position of the Endocrine Society.


The educational content in this self-assessment test relates to basic principles of diagnosis and therapy and does not substitute for individual patient assessment based on the health care provider’s examination of the patient and consideration of laboratory data and other factors unique to the patient. Standards in medicine change as new data become available.


When prescribing medications, the physician is advised to check the product information sheet accompanying each drug to verify conditions of use and to identify any changes in drug dosage schedule or contraindications.


The Endocrine Society has determined that disclosure of unlabeled/off-label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation. Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration (FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.


The Endocrine Society will record learner’s personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties.


This activity is not supported by educational grant(s) or other funds from any commercial supporter.

Accreditation Statement

The Endocrine Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Endocrine Society has achieved Accreditation with Commendation.

The Endocrine Society designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Expiration Date

July 31, 2020 (date after which this enduring material is no longer certified for AMA PRA Category 1 Credits)

Available Credit

  • 0.50 AMA PRA Category 1 Credits
  • 0.50 CME Certificate of Participation

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