Endocrine deficit after fractionated total body irradiation.

Abstract

Endocrine function was assessed in 31 children (17 boys) after fractionated total body irradiation used in the preparative regimen for bone marrow transplantation. Endocrine dysfunction was present in 25 children. Fifteen of 29 had growth hormone insufficiency 0-9-4-9 years after total body irradiation, yet only three of the 15 had received previous cranial irradiation. Five of 30 had thyroid dysfunction: two with a low thyroxine and raised thyroid stimulating hormone (TSH) concentration and three with a raised TSH and normal thyroxine concentration. Thus the incidence of thyroid dysfunction (16%) is much lower than that reported after single fraction total body irradiation (39-59%). In only two children were abnormalities of the hypothalamicpituitary-adrenal axis demonstrated. The majority of pubertal children assessed (n= 15) showed evidence of gonadal damage. All the pubertal girls (n=5) had ovarian failure, although there was evidence of recovery of ovarian function in one girl. All seven boys in late puberty showed evidence of damage to the germinal epithelium, and two of three in early puberty had raised follicle stimulating hormone concentrations. Despite the use of a fractionated total body irradiation regimen, endocrine morbidity is substantial and children undergoing such procedures wili require long term endocrine review and management.

Endocrine dysfunction and parameters of the metabolic syndrome after bone marrow transplantation during childhood and adolescence

“…Many studies have reported a significant incidence of GH deficiency following cranial irradiation, 19,23 and also after TBI. 24 This association was documented in our group as well. Growth hormone treatment after BMT has usually been reported to result in increase in growth velocity, albeit a smaller one than in children with idiopathic GH deficiency, which is probably caused by the lesions induced by TBI.…”

“…Three patients (3.3%) were diagnosed with type II diabetes mellitus and three (3.3%) with IGT at a mean age of 21.576.1 years (range, [15][16][17][18][19][20][21][22][23][24][25][26][27][28]. A BMI-SDS of o2 was noted in all three patients with diabetes and in two of the three patients with IGT.…”

Patterns of gonadal dysfunction following bone marrow transplantation

“…[2][3][4][5][8][9][10][11][12][13] Our experience is similar in that the overwhelming majority of patients experience some degree of gonadal dysfunction following BMT. In our analysis, older age at BMT was a consistent and important risk factor for developing gonadal dysfunction over time.…”

Autologous bone marrow transplantation for childhood acute lymphoblastic leukaemia in second remission – long-term follow-up

“…25 The incidence of thyroid dysfunction, both overt hypothyroidism and TSH abnormalities was lower with a fractionated schedule of TBI. 26 We conclude that ABMT offers an alternative therapeutic modality in children with ALL in second remission particularly for those with a long first remission. The availability of unrelated donor BMT and its comparable regimenrelated mortality to that of sibling BMT 27,28 has largely reduced the use of ABMT, particularly in children with early relapse, because of the hope of exploiting a graftversus-leukaemia effect.…”