Cohen A, Rovelli R, Zecca S, Van-Lint M T, Parodi L, Grasso L, Uderzo C
Pediatric Endocrinology Unit, Gaslini Institute, Children's Hospital, Genoa, Italy.
Bone Marrow Transplant. 1998 Apr;21 Suppl 2:S64-7.
With the increasing use and success of BMT, larger numbers of children survive transplantation. Still, cancer treatment in children causes damage to the endocrine glands, often inducing growth deficiency, pubertal delay and thyroid dysfunction. This paper will deal with some of the most common endocrine disorders related to BMT in the pediatric population. Irradiation is the major contributor for growth impairment after BMT, acting through lesion to epiphyseal growth-plate, gonadal damage with delayed or precocious puberty, hypothyroidism, and growth hormone insufficiency. Gonadal dysfunction can be induced both by a direct injury to the gonads (irradiation, gonadotoxic agents) causing primary hypergonadotropic-hypogonadism, and with less frequency, by neuroendocrine injury to the hypothalamo-pituitary axis causing hypogonadotropic-hypogonadism. It seems that both doses of chemotherapy and of irradiation used by different regimens, fractionation of irradiation, and age at the time of BMT are the most important factors when we deal with toxic endocrine late-effects in long term survivors. In order to improve the quality of life of each single patient who receive BMT, and without inflicting the success-rate of this procedure, we recommend a life-long surveillance to prevent or to treat symptoms and disorders caused by hormone deficiencies, and we also advocate for a multidisciplinary team-approach that includes an endocrinologist consultant.
随着骨髓移植（BMT）的使用日益增加且取得成功，越来越多的儿童在移植后存活下来。然而，儿童癌症治疗会对内分泌腺造成损害，常常导致生长发育迟缓、青春期延迟和甲状腺功能障碍。本文将探讨儿科人群中与BMT相关的一些最常见的内分泌疾病。放射治疗是BMT后生长障碍的主要原因，其作用途径包括损伤骨骺生长板、性腺损害导致青春期延迟或早熟、甲状腺功能减退以及生长激素不足。性腺功能障碍可由性腺直接损伤（放射治疗、性腺毒性药物）导致原发性高促性腺激素性性腺功能减退引起，较少见的是由下丘脑 - 垂体轴的神经内分泌损伤导致低促性腺激素性性腺功能减退引起。对于长期存活者的毒性内分泌晚期效应而言，不同治疗方案中使用的化疗和放射治疗剂量、放射治疗的分割方式以及进行BMT时的年龄似乎是最重要的因素。为了提高接受BMT的每一位患者的生活质量，同时又不影响该治疗方法的成功率，我们建议进行终身监测，以预防或治疗激素缺乏引起的症状和疾病，并且我们还提倡采用包括内分泌科顾问在内的多学科团队方法。
