Signs and Symptoms Prompting Immediate Evaluation

Survivors of childhood cancer with any of the following 10 symptoms should be referred for a neuroen-docrinopathy evaluation:

(1) slow growth rate or failure to show catch up growth; (2) failure to thrive; (3) obesity; (4) persistent fatigue or anorexia; (5) polydipsia and polyuria; (6) severely dry skin or thin and brittle hair; (7) altered timing of onset of puberty (e.g. signs of puberty before age 9 years or, in patients with short height, failure to enter puberty by age 12 years in girls and 13 years in boys); (8) abnormal tempo of puberty (e.g. rapid or interrupted progression of puberty); (9) galactorrhea; and (10) abnormal menstruation or sexual function.

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