Function of the hypothalamic-pituitary-gonadal axis in long-term survivors of hematopoietic stem cell transplantation for hematological diseases.
Gonadal dysfunction in adult long-term survivors of hematopoietic stem cell transplantation (HSCT) is an adverse effect of conditioning regimens consisting of chemotherapy and total body irradiation (TBI). The impact of conditioning regimens consisting of chemotherapy alone on the function of the hypothalamic-pituitary-gonadal (HPG) axis was evaluated in a series of 41 female and 31 male patients who had undergone either autologous or allogeneic bone marrow/peripheral blood stem cell transplantation; mean age at transplantation was 32.6 years and mean time interval from transplantation was 1.5 years (range 0.2-9.8 years). Provocative testing of the HPG axis by administration of luteinizing hormone-releasing hormone was included in the first endocrinological evaluation. The follow-up period extended to three consecutive years. Gonadal dysfunction was not reported by any of the patients prior to their underlying illness. Hypergonadotrophic hypogonadism was observed in 97% of female and 19% of male patients. Leydig cell strain (normal testosterone, high luteinizing hormone levels) was evident in 32% and spermatogenesis damage (high follicle-stimulating hormone levels) in 68% of the male population. At the conclusion of the study four women (10%) had regained spontaneous menses and all hypogonadal men had resumed normal testosterone levels. Our results indicate a high incidence of gonadal dysfunction due to target organ failure in HSCT recipients not treated by TBI.
Somali
Maria
M
Endocrinology Department, Hippokratio General Hospital, Thessaloniki, Greece. somali@otenet.gr
Mpatakoias
Vassilios
V
Avramides
Avraam
A
Sakellari
Ioanna
I
Kaloyannidis
Panayotis
P
Smias
Christos
C
Anagnostopoulos
Achilleas
A
Kourtis
Anargyros
A
Rousso
David
D
Panidis
Dimitrios
D
Vagenakis
Apostolos
A
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D015914:Estrogen Replacement Therapy; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006058:Gonadal Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007987:Gonadotropin-Releasing Hormone; D006066:Gonads / Q000503:physiopathology*; D006086:Graft vs Host Disease / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D020249:Hormone Replacement Therapy; D006801:Humans; D007031:Hypothalamus / Q000503:physiopathology*; D007248:Infertility, Male / Q000453:epidemiology / Q000209:etiology; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010902:Pituitary Gland / Q000503:physiopathology*; D017741:Survivors; D013739:Testosterone / Q000008:administration & dosage; D019172:Transplantation Conditioning / Q000009:adverse effects; D014182:Transplantation, Autologous
D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone