Introduction: Successful treatment for childhood-onset Hodgkin lymphoma (HL) has highlighted long-term effects of therapy. We review endocrinopathy in HL survivors attending a hospital follow-up clinic and consider, together with published data, appropriate disease screening and monitoring.
Method: Retrospective review of notes and investigations from survivors of childhood HL ≥5 years from diagnosis.
Results: Forty-four subjects were included (30 male, 14 female). Mean age at diagnosis was 10.6±3.5 years; mean follow-up 23.6±8.3 years. Thirty-five (79.5%) had received chemotherapy with or without radiotherapy. Thirty-two (72.7%) had received radiotherapy, 29 including the neck (median dose 35 Gy).
Mean height was 163.0 cm (females) and 175.5 cm (males). Median BMI was BMI 27.5 (females) and 24.5 (males) with 27 subjects (61%) of BMI ≥25. Routine diabetes mellitus screening was not performed but there were no diagnosed cases. Mean total cholesterol (n=27) was 4.8 mmol/l in females and 5.5 mmol/l in males; 17 subjects had cholesterol ≥5 mmol/l.
Where documented, for females, mean age at menarche was 13.7 years. Three women (all over 40 years) had LH/FSH >20 U/l, with a further 4 on HRT or contraceptive pill. In 10 females with reproductive data available; 7 had had spontaneous pregnancies (9 offspring).
In males, mean testosterone was 12.9 nmol/l (n=26) and 2 patients had required testosterone replacement. Seven men with azoospermia and 3 with oligospermia were noted all had had chemotherapy (one with additional groin radiotherapy).
Thyroid status was available for 43 subjects; 11 (25.6%) had no disease, 30 (69.8%) were taking thyroxine (mean dose 124 mg daily). Of these, 26 (60.5%) had nodular disease (25 of whom had received neck radiotherapy), and 2 had had differentiated thyroid carcinoma.
Conclusion: Long-term follow up, identification of risk factors and careful documentation of late effects together with appropriate screening may enable identification and treatment of morbidity in patients cured of childhood HL.