Giona F, Annino L, Donato P, Ermini M
Department of Human Biopathology, University La Sapienza, Rome, Italy.
Haematologica. 1994 Mar-Apr;79(2):141-7.
The limited and controversial data available regarding endocrine function in adults treated for acute lymphoblastic leukemia (ALL) prompted us to study the influence of chemotherapy on gonadal, adrenal androgen and thyroid function. Forty-eight ALL adults (30 men and 18 women) in first complete remission (CR) were investigated.
Severe reproductive function impairment was detected in 10/12 males receiving treatment, while endocrine function was affected in only 1 case. All but one off-therapy male showed normal reproductive function; moreover, endocrine function was impaired in only one male. Eight of 10 females receiving treatment showed hypergonadotropinemia and decreased estrogen levels. All off-therapy women reported regular menses, even though mild hypergonadotropinemia persisted in only 2 cases. Adrenal androgen function was depressed in 12/22 on-therapy patients in both sexes, and in 6/17 off-therapy males. All off-therapy females recovered completely. Dihydroepiandrosterone-sulfate (DHEA-S) serum levels were significantly correlated to the length of time-off therapy (p = 0.003), and inversely correlated to the age at diagnosis (p < 0.0001) in off-therapy males. All patients remained euthyroid, although 4 patients showed subclinical impairment of thyroid function.
Our experience suggests that long-term prospective studies for ALL adults are necessary in order to better define the magnitude and duration of influence the chemotherapy has on endocrine function.
关于接受急性淋巴细胞白血病（ALL）治疗的成人内分泌功能的现有数据有限且存在争议，这促使我们研究化疗对性腺、肾上腺雄激素和甲状腺功能的影响。对48例处于首次完全缓解（CR）期的成年ALL患者（30例男性和18例女性）进行了调查。
在接受治疗的12例男性中，有10例检测到严重的生殖功能损害，而内分泌功能仅1例受影响。除1例停止治疗的男性外，所有男性的生殖功能均正常；此外，仅1例男性的内分泌功能受损。接受治疗的10例女性中有8例出现高促性腺激素血症和雌激素水平降低。所有停止治疗的女性月经均规律，尽管仅2例仍存在轻度高促性腺激素血症。两性中，12/22例正在接受治疗的患者以及6/17例停止治疗的男性肾上腺雄激素功能受到抑制。所有停止治疗的女性均完全恢复。在停止治疗的男性中，硫酸脱氢表雄酮（DHEA-S）血清水平与停止治疗的时间长度显著相关（p = 0.003），与诊断时的年龄呈负相关（p < 0.0001）。所有患者甲状腺功能均正常，尽管有4例患者表现出亚临床甲状腺功能损害。
我们的经验表明，有必要对成年ALL患者进行长期前瞻性研究，以便更好地确定化疗对内分泌功能影响的程度和持续时间。
