Objective: To review impact of childhood cancer treatment on endocrine, gonadal and thyroid function.
Methods: Retrospective review of electronic records of 79 females, 90 males over 6 months of clinic visits from a Late Effects of childhood cancer clinic. Age at diagnosis: 8.5 years (range 5 months9 years); time from treatment 23.5 years (range 1040). Diagnoses: ALL, AML, Hodgkins lymphoma, Non-Hodgkins lymphoma, sarcomas, Wilms, Neuroblastoma, Primitive neuroectodermal tumour. Treatment regimens: chemotherapy (CHT), cranial radiotherapy (RT), total body irradiation (TBI) testicular, lung, regional RT, haemopoetic stem cell transplant (HCST). Endocrine, reproductive function, thyroid status, thyroid cancer, multinodular goitre (MNG) were noted.
56/79 women had regular periods, 30/79 became pregnant. 15/79 had POI. 7/90 had other pregnancy risks (uterine RT/anthracycline exposure). For oestrogen replacement in POI: 12 HRT, 3 OCP and one, none.
Males: 14/90 men documented as having children. 15/90 had testicular failure, 12 on testosterone. 15/90 had azoospermia including 6 having endocrine testicular failure on replacement (TBI or cranial/testicular RT and alkylating agents). 44/90 reproductive status was undocumented.
Thyroid: 4/169 patients had MNG; 1 follicular thyroid cancer, none of whom had neck RT. 20/169 diagnosed hypothyroidism. None had documented TSH >10 mIU/l. 9/20 had RT involving the thyroid. GH was the commonest hormone deficiency and ACTH the least common.
Discussion: There is a differential effect of CHT and RT treatment in men: CHT affects sertoli cell function, whereas heavily treated men (RT and CHT) are azoospermic requiring testosterone replacement. As well as issues conceiving, pregnancy can be high risk. Young women with POI are taking more HRT contrary to suggestion that its use may be stigmatised. Thyroid status is uncertain with a low threshold for starting thyroxine. These young adults have complex and multiple health needs. As this patient group increases in number we need to develop services accordingly.