Development in autologous bone marrrow transplantation (auto-BMT) has improved survival, but new endocrine complications now emerge. If primary thyroid and gonadal deficiencies are documented in medical literature, pituitary deficiencies are less well-known, especially in adults. The aim of the study was to investigate pituitary function in patients who survived at least one year after transplantation for malignant haematologic disorders by a prospective study.
Material and methods: Thirty patients (17 male, 13 female) were studied. Age at transplantation ranged from 7 to 67 years. Preparation of patients had included total body irradiation (TBI) in eight patients, only cytotoxic drug in 22 patients. In 17 patients, immunotherapy (interferon and interleukine-2) was used. Corticosteroid treatment had been stop for at least 6 month. Prospective hormonal analysis was effectuated, including basic dosages (TSH, T4L, IGF1, FSH, LH, E2/T, PRL), and dynamic test of hypothalamus-pituitary axis (HPA) with insulin tolerance test (ITT) on GH and cortisol or adrenocorticotropin (ACTH) test (corticotrophin 1 μg IV) if contraindication or insulin resistance.
Results: Seven patients (24.1%) had central hypothyroidism. Secondary adrenal insufficiency was diagnosed in 2 subjects. GH deficiency was diagnosed in 7 subjects (1 severe, 6 partial). Eight no menopausal women before allo-BMT had primary ovarian insufficiency. Four male presented central hypogonadism.
Sixteen patients (64%) had one pituitary deficiency, 1 had 2 deficiencies and 2 had 3 deficiencies. No global HPA deficiency was found.
Discussion: Two majors factors seem to be important for developing endocrine dysfunctions: conditioning treatment before auto-BMT: TBI and cytotoxics drugs or corticosteroid used before BMT. Considering these results, a systematic screening of pituitary deficiencies after auto-BMT could be proposed in order to improve patient quality of life after transplantation.
03 - 07 May 2008
European Society of Endocrinology