Somali Maria, Mpatakoias Vassilios, Avramides Avraam, Sakellari Ioanna, Kaloyannidis Panayotis, Smias Christos, Anagnostopoulos Achilleas, Kourtis Anargyros, Rousso David, Panidis Dimitrios, Vagenakis Apostolos
Endocrinology Department, Hippokratio General Hospital, Thessaloniki, Greece.
Gynecol Endocrinol. 2005 Jul;21(1):18-26. doi: 10.1080/09513590500099255.
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.
造血干细胞移植（HSCT）成年长期存活者的性腺功能障碍是由化疗和全身照射（TBI）组成的预处理方案的一种不良反应。在41名女性和31名男性患者中评估了仅由化疗组成的预处理方案对下丘脑 - 垂体 - 性腺（HPG）轴功能的影响，这些患者均接受了自体或异基因骨髓/外周血干细胞移植；移植时的平均年龄为32.6岁，移植后的平均时间间隔为1.5年（范围0.2 - 9.8年）。首次内分泌评估包括通过给予促黄体生成素释放激素对HPG轴进行激发试验。随访期延长至连续三年。在这些患者患基础疾病之前，没有任何患者报告过性腺功能障碍。97%的女性和19%的男性患者出现高促性腺激素性性腺功能减退。32%的男性表现为睾丸间质细胞株（睾酮正常，促黄体生成素水平高），68%的男性表现为生精损害（促卵泡生成素水平高）。在研究结束时，4名女性（10%）恢复了自然月经，所有性腺功能减退的男性睾酮水平恢复正常。我们的结果表明，未接受TBI治疗的HSCT受者因靶器官衰竭导致性腺功能障碍的发生率很高。
