title: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation.
abstract: Allogeneic hematopoietic stem cell transplantation is mainly indicated in bone marrow dysfunction related to blood diseases, but also in some rare diseases (adrenoleucodystrophy, mitochondrial neurogastrointestinal encephalomyopathy or MNGIE...). After decades, this treatment has proven to be efficient at the cost of numerous early and delayed side effects such as infection, graft-versus-host disease, cardiovascular complications and secondary malignancies. These complications are mainly related to the conditioning, which requires a powerful chemotherapy associated to total body irradiation (myelo-ablation) or immunosuppression (non myelo-ablation). Among side effects, the endocrine complications may be classified as 1) hormonal endocrine deficiencies (particularly gonado- and somatotropic) related to delayed consequences of chemo- and above all radiotherapy, with their consequences on growth, puberty, bone and fertility); 2) auto-immune diseases, particularly dysthyroidism; 3) secondary tumors involving either endocrine glands (thyroid carcinoma) or dependent on hormonal status (breast cancer, meningioma), favored by immune dysregulation and radiotherapy; 4) metabolic complications, especially steroid-induced diabetes and dyslipidemia with their increased cardio-vascular risk. These complications are intricate. Moreover, hormone replacement therapy can modulate the cardio-vascular or the tumoral risk of patients, already increased by radiotherapy and chemotherapy, especially steroids and anthracyclins... Therefore, patients and families should be informed of these side effects and of the importance of a long-term follow-up requiring a multidisciplinary approach.
authors.affiliation: Lille University Hospital, Endocrinology and Metabolism, Lille, France. mc-vantyghem@chru-lille.fr.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Vantyghem
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.forename: Christine
authors.initials: C
authors.lastname: Decanter
authors.forename: Frédérique
authors.initials: F
authors.lastname: Defrance
authors.forename: Wassila
authors.initials: W
authors.lastname: Karrouz
authors.forename: Clara
authors.initials: C
authors.lastname: Leroy
authors.forename: Kristell
authors.initials: K
authors.lastname: Le Mapihan
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Couturier
authors.forename: Eva
authors.initials: E
authors.lastname: De Berranger
authors.forename: Eric
authors.initials: E
authors.lastname: Hermet
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.forename: Ambroise
authors.initials: A
authors.lastname: Marcais
authors.forename: Sylvie
authors.initials: S
authors.lastname: Francois
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D019468:Disease Management; D004700:Endocrine System Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000639:trends; D020249:Hormone Replacement Therapy / Q000379:methods / Q000639:trends; D006801:Humans; D008659:Metabolic Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*