Feyer P, Titlbach O, Hoffmann F A, Kubel M, Helbig W
Clinic of Radiology, Karl-Marx-University, Leipzig, G.D.R.
Folia Haematol Int Mag Klin Morphol Blutforsch. 1989;116(3-4):547-52.
The present report describes our data regarding changes of endocrine parameters after total body irradiation (TBI) and bone marrow transplantation (BMT). Endocrine glands are usually resistant to irradiation under morphological aspects. But new methods of determination and sensitive tests were developed in the last few years. Now it is possible to detect already small functional changes. Endocrine studies in the course of the disease were followed serially at 16 patients with TBI and BMT. Pretransplant conditioning consisted of single-dose irradiation combined with a high-dose, short-term chemotherapy. Reactions of the endocrine system showed a defined temporary order. Changes of ACTH and cortisol were in the beginning. The pituitary-adrenal cortex system responds in a different way. The pituitary-thyroid system develop a short-term "low-T3-syndrome" reflecting the extreme stress of the organism. At the same time we obtained an increase of thyroxine. Testosterone and luteotropic hormone, the sexual steroids showed levels representing a primary gonadal insufficiency. The studies in the posttransplant period yielded a return to the normal range at most of the hormonal levels with the exception of the sexual steroids. Sterility is one of the late effects of TBI. A tendency towards hypothyroidism could be noticed in some cases being only subclinical forms. Reasons and possible therapy are discussed.
本报告描述了我们关于全身照射（TBI）和骨髓移植（BMT）后内分泌参数变化的数据。内分泌腺在形态学方面通常对辐射具有抗性。但在过去几年中开发了新的测定方法和敏感测试。现在已经能够检测到微小的功能变化。对16例接受TBI和BMT的患者在疾病过程中进行了系列内分泌研究。移植前预处理包括单剂量照射联合高剂量短期化疗。内分泌系统的反应呈现出明确的暂时顺序。促肾上腺皮质激素（ACTH）和皮质醇的变化在开始时出现。垂体 - 肾上腺皮质系统的反应方式不同。垂体 - 甲状腺系统出现短期的“低T3综合征”，反映了机体的极端应激状态。与此同时，甲状腺素增加。睾酮和促黄体激素，即性类固醇，显示出代表原发性性腺功能不全的水平。移植后时期的研究表明，除性类固醇外，大多数激素水平恢复到正常范围。不育是TBI的晚期效应之一。在某些情况下可注意到有亚临床形式的甲状腺功能减退倾向。对原因和可能的治疗方法进行了讨论。
