Lackner H, Schwingshandl J, Pakisch B, Knoblauch S, Mutz I, Urban C
Universitäts-Kinderklinik, Graz.
Wien Klin Wochenschr. 1991;103(19):581-4.
Endocrinological function was evaluated in 31 children after successful treatment of acute lymphoblastic leukaemia. All patients had received combination chemotherapy and 12-24Gy of cranial irradiation according to the German therapy protocols BFM-81, BFM-83 and BFM-86. Height, weight, bone age and pubertal development, as well as hypothalamic-pituitary function were measured. Long-term linear growth was unaffected in all patients. However, 9 patients showed subnormal serum growth hormone levels in response to pharmacological stimulation of the pituitary. All patients had normal levels of T3 and T4, but one patient showed an increased response of thyrotropin to thyrotropin releasing hormone. All prepubertal and postpubertal children demonstrated appropriate secretion of follicle-stimulation hormone (FSH) and luteinizing hormone (LH) after stimulation with LH-releasing hormone (LH-RH). 3 pubertal girls showed adequate oestradiol levels, but abnormally high levels of gonadotropins in response to LH-RH. Sexual development was normal in two of them, but the third had a late menarche and irregular menses. The significance of these findings is discussed in the context of recommendations possibly to further reduce or completely delete prophylactic cranial irradiation.
对31名急性淋巴细胞白血病治疗成功后的儿童进行了内分泌功能评估。所有患者均按照德国治疗方案BFM - 81、BFM - 83和BFM - 86接受了联合化疗和12 - 24Gy的颅脑照射。测量了身高、体重、骨龄、青春期发育以及下丘脑 - 垂体功能。所有患者的长期线性生长均未受影响。然而，9名患者在垂体受到药物刺激后血清生长激素水平低于正常。所有患者的T3和T4水平正常，但有1名患者促甲状腺激素对促甲状腺激素释放激素的反应增强。所有青春期前和青春期后的儿童在接受促黄体生成素释放激素（LH - RH）刺激后，促卵泡生成素（FSH）和促黄体生成素（LH）分泌正常。3名青春期女孩雌二醇水平正常，但对LH - RH反应的促性腺激素水平异常升高。其中2人性发育正常，但第3人初潮延迟且月经不规律。在可能进一步减少或完全取消预防性颅脑照射的建议背景下，讨论了这些发现的意义。
