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After treatment and remission

Growth and hormones

Leukaemia treatment sometimes affects a child’s growth and hormone system. This topic explains which changes are possible, how they are monitored and how they are treated.

Last updated: ~3 min read
Lines of light rising across a grid.
Figure 1.Monitoring growth — Growth and hormones

01Short answer

Hormones are chemical “messengers” that control growth, metabolism, puberty and energy. They are made by the pituitary gland in the brain, the thyroid (topic “Hormones”), the adrenal glands, the ovaries and the testes. Most treatment for childhood leukaemia does not seriously affect hormones, but some treatments raise the risk: radiotherapy to the head (now rarely used), total body irradiation and stem cell transplantation, some chemotherapy drugs at high doses, and long-term steroids. Possible changes: growth hormone deficiency — height increasing more slowly than expected; puberty starting early (especially in girls after radiotherapy to the head) or late; an underactive thyroid; weight gain and metabolic changes (topic “Weight”); and reduced bone density (topic “Liver”). Monitoring: height and weight are measured at each visit and compared on a growth chart; the stages of puberty are checked; and if needed, hormone blood tests and a bone age X-ray are done. If there is a risk, a referral is made to a paediatric endocrinologist. Treatment: for growth hormone deficiency, daily injections can help growth; thyroid and sex hormones can be replaced with tablets or other methods. The choice and timing of these treatments is a joint decision by the endocrinologist and haematologist.

02Simple explanation

Hormones are messengers for growth and puberty.

Risk: head radiotherapy, transplant, steroids.

At every visit: height and weight.

If needed: an endocrinologist.

Many problems can be treated.

03Scientific explanation

Endocrine late effects: according to the NCI PDQ, endocrine problems are among the most common late effects in childhood cancer survivors, especially after radiotherapy to the head and transplantation.

Growth hormone: MedlinePlus explains that growth hormone deficiency shows as slow growth and is treated with hormone therapy.

Monitoring: the COG recommends regular checks of height, weight and puberty in survivors at risk.

Late effects: the ACS stresses the importance of finding changes in growth and hormones early.

04What happens in the body?

What do hormones do?

They control growth, metabolism, puberty and energy. Several glands make them.

Points of light joined by fine lines.
Figure 3.A network of hormone glands.

Who is at higher risk?

Children who had radiotherapy to the head or whole body, a stem cell transplant or some drugs at high doses.

Monitoring growth

Height and weight are measured at each visit and compared on a chart. You can keep records at home too.

Puberty

It may start too early or too late. The doctor checks its stages and orders tests if needed.

Marks of light on a doorframe.
Figure 2.Measuring height over the years.

Treatment

Replacing growth hormone, thyroid hormone and sex hormones. The choice is made with the endocrinologist.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Protecting growth

Steps.

Measure — Height and weight.1MeasureHeight and weight.
Puberty — Puberty.2PubertyPuberty.
Tests — Hormone tests.3TestsHormone tests.
Endocrinologist — Endocrinologist.4EndocrinologistEndocrinologist.
MonitoringGrowth is followed.
DetectionProblems are found early.
TreatmentTreatment if needed.

06Possible hormone changes (simplified)

ChangeWhat it may be linked to
Slow growthGrowth hormone deficiency
Early pubertyRadiotherapy to the head
Delayed pubertyDamage to the ovaries or testes
Tiredness, weight gainAn underactive thyroid
Weak bonesSteroids, hormone deficiency

* Your doctor works out your own risk from your treatment summary.

07Key terms

Hormone
A chemical messenger made by glands.
Pituitary gland
The main hormone gland in the brain.
Endocrinologist
A hormone specialist.
Growth chart
A chart comparing height with age.
Bone age
How mature the bones look on an X-ray.
Puberty
The change from childhood to adulthood.

08Key points

  • Have height and weight measured at each visit.
  • Compare the measurements.
  • Tell the doctor about changes in puberty.
  • Keep the treatment summary.
  • See an endocrinologist if needed.
  • Follow any treatment prescribed.

09Frequently asked questions

My child is shorter than their friends.

Height varies; the doctor will assess the rate of growth.

Is growth hormone safe?

That is a joint decision by the endocrinologist and haematologist.

Puberty started very early.

Tell the doctor; treatment is possible.

Can hormone problems appear later?

Yes, even years later; that is why follow-up is long.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. My child is shorter than their friends.

  2. Is growth hormone safe?

  3. Puberty started very early.

  4. Can hormone problems appear later?

  5. Does this information replace medical advice?

My questions

12Sources

  1. National Cancer Institute. Late Effects of Treatment for Childhood Cancer (PDQ®)
  2. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  3. MedlinePlus (U.S. National Library of Medicine). Growth hormone deficiency – children
  4. MedlinePlus (U.S. National Library of Medicine). Growth Disorders
  5. American Cancer Society. Late Effects of Childhood Cancer Treatment
  6. National Cancer Institute (NCI). Follow-Up Medical Care
  7. National Cancer Institute (NCI). Cancer Survivorship
  8. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  9. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  10. National Cancer Institute. Facing Forward: Life After Cancer Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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