Was a pleasure to deliver a lecture on neuroendocrine #lateeffects of #childhoodcancer to @LondonPaeds @RCPCHtweets trainees today. Some top tips ICYMI (aka how to make a paediatric endocrinologist happy):
1) Measure children at diagnosis (weight AND height). Very useful for future monitoring. If you can assess puberty too.
2) Do baseline pituitary function (ACTH/cortisol (ideally morning), TFTs, U&Es; IGF-1, LH, FSH, testosterone/ estradiol) ideally for all brain tumours (and definitely for all sellar/ suprasellar tumours) at diagnosis, in that priority order if you can't get enough blood.
3) Do the cortisol +/- ACTH BEFORE giving dexamethasone (because it will suppress endogenous secretion), document this clearly and you will earn extra brownie points.
4) Survival does not equal health. Think of brain tumours as a form of brain injury, like in trauma. Neurorehabilitation and community paediatric support often required.
5) Ensure all patients who have had cranial irradiation and/ or a suprasellar/ sellar tumour are being seen by a paediatric endocrinologist. All patients who have had childhood cancer should have growth and puberty monitored regularly regardless.
6) Endocrine dysfunction, particularly hypopituitarism can evolve over a lifetime so just because there is none now doesn't mean there will be none ever.
7) Lastly young people are much more aware and able to take about fertility preservation than many of us health professionals (or their parents) are.
8) Realise I missed a really important one! Also remember to measure prolactin, AFP and beta-hCG with any suprasellar/ sellar lesion. Always the possibility of being caught out e.g. craniopharyngioma turning out to be prolactinoma. Treatment can be very different.
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