Recommended monitoring for endocrine toxicities in children and adolescents with CML on TKI
| Parameter . | Potential changes . | Recommended monitoring . | Management . |
|---|---|---|---|
| Growth | Growth attenuation | Accurate height and weight at each visit | Referral to endocrinologist for possible GH stimulation testing |
| Close monitoring of growth velocity | |||
| Calculate prospective height from mid parental height | |||
| Bone | Dysregulation of bone remodeling | DEXA scan if radiograph indicates low bone mineral density or unprovoked fractures occur | Referral to endocrinologist |
| Altered calcium, phosphate, and vitamin D metabolism | |||
| Thyroid | Hypothyroidism | TSH and free T4 levels every 4-6 wk after initiation of therapy; every 6-12 mo thereafter or with symptoms suggestive of hypo- or hyperthyroidism | Referral to endocrinologist and consider thyroid hormone replacement therapy |
| Hyperthyroidism | |||
| Gonadal function | Delayed puberty | Accurate Tanner staging at reasonable intervals | Referral to endocrinologist for delayed puberty |
| Gonadal dysfunction | Check gonadotropins and sex steroids for delayed puberty or gonadal dysfunction | Offer sperm cryopreservation to pubertal males | |
| Potentially decreased fertility | Fertility preservation before therapy may be discussed | ||
| Pregnancy outcome | Fetal abnormalities | Pregnancy test at initiation of therapy for female patients of childbearing age | Recommend counseling on contraceptives for female patients of childbearing age. Efforts should be made to increase the chance of TKI discontinuation to facilitate safe pregnancies in adult life. |
| Parameter . | Potential changes . | Recommended monitoring . | Management . |
|---|---|---|---|
| Growth | Growth attenuation | Accurate height and weight at each visit | Referral to endocrinologist for possible GH stimulation testing |
| Close monitoring of growth velocity | |||
| Calculate prospective height from mid parental height | |||
| Bone | Dysregulation of bone remodeling | DEXA scan if radiograph indicates low bone mineral density or unprovoked fractures occur | Referral to endocrinologist |
| Altered calcium, phosphate, and vitamin D metabolism | |||
| Thyroid | Hypothyroidism | TSH and free T4 levels every 4-6 wk after initiation of therapy; every 6-12 mo thereafter or with symptoms suggestive of hypo- or hyperthyroidism | Referral to endocrinologist and consider thyroid hormone replacement therapy |
| Hyperthyroidism | |||
| Gonadal function | Delayed puberty | Accurate Tanner staging at reasonable intervals | Referral to endocrinologist for delayed puberty |
| Gonadal dysfunction | Check gonadotropins and sex steroids for delayed puberty or gonadal dysfunction | Offer sperm cryopreservation to pubertal males | |
| Potentially decreased fertility | Fertility preservation before therapy may be discussed | ||
| Pregnancy outcome | Fetal abnormalities | Pregnancy test at initiation of therapy for female patients of childbearing age | Recommend counseling on contraceptives for female patients of childbearing age. Efforts should be made to increase the chance of TKI discontinuation to facilitate safe pregnancies in adult life. |
GH, growth hormone; DEXA, dual-energy x-ray absorptiometry; T4, thyroxine TSH, thyroid-stimulating hormone.