Growth following malignancy.
Disturbed growth in the child surviving cancer is multifactorial. This chapter examines the evidence for, and the difficulties in determining, individual drug treatment or disease effects at multiple endocrine levels influencing growth and against a changing baseline of adjuvant cancer therapies with potentially additive toxicity. The evolutionary pattern and potential aetiology of the neuro-endocrine deficit and growth-plate disturbance, the (unrandomized) effects of hormone replacement therapy and areas which require further study are also addressed. The reasons why growth hormone (GH) secretion is so exquisitely sensitive to disturbance, even though deficiencies soon after lesser cranial insults can be difficult to detect, are explored with evidence cited from the few existing prospective and interventional studies. The extent and nature of the hypothalamo-pituitary disturbance needs further prospective interventional study and disease-site- and treatment-specific comparisons. Practical treatment and surveillance strategies to optimize growth potential, age-appropriate development, peak bone mineral accretion, hair re-growth and future health and well-being are also suggested. Health-related outcomes resulting from today's newer therapies and enhanced surveillance need documenting in future (inter)national cancer trials, where randomized studies of hormonal intervention may also become possible.
Spoudeas
Helen A
HA
London Centre for Paediatric Endocrinology: UCLH and GOSH Hospitals, Neuro-Endocrine/Oncology Division, 3rd Floor Dorville House, Middlesex Hospital, Mortimer Street, London W1N 8AA, UK.
D000311:Adrenal Glands / Q000503:physiopathology / Q000528:radiation effects; D015519:Bone Density; D001932:Brain Neoplasms / Q000532:radiotherapy; D006128:Growth; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D009490:Neurosecretory Systems / Q000503:physiopathology / Q000528:radiation effects; D011878:Radiotherapy / Q000009:adverse effects; D013961:Thyroid Gland / Q000503:physiopathology / Q000528:radiation effects
D013006:Growth Hormone