Endocrinopathy after bone marrow transplant
Endocrinopathy | Risk factors |
---|---|
BMD, bone mineral density. | |
Short stature | • Total body irradiation |
• Previous cranial radiation | |
• Growth hormone deficiency | |
• Chronic graft versus host disease | |
• Poor nutrition/malabsorption | |
Growth hormone insufficiency | • Total body irradiation |
• Previous cranial radiation | |
Thyroid dysfunction | Hypothyroidism |
• Females | |
• Total body irradiation | |
• Busulphan/cyclophosphamide conditioning (lower risk than total body irradiation) | |
Thyroid nodules | |
• Females | |
• Younger age at treatment | |
Hyperthyroidism (rare) | |
• Total body irradiation | |
Thyroid cancer | |
• Increased time from treatment | |
• Younger age at treatment | |
• Females | |
Gonadal dysfunction | Female |
• Older age at treatment | |
• Total body irradiation | |
• Busulphan | |
Male | |
• Radiation ⩾4 Gy—azoospermia very likely | |
• Radiation ⩾20 Gy—Leydig cell failure likely (testicular boost for testicular relapse is 24 Gy) | |
• Bulsuphan | |
• Effect of age unclear | |
Adrenal insufficiency | • Chronic graft versus host disease |
Reduced BMD | • Hypogonadism |
• Chronic graft versus host disease | |
• Inactivity | |
• Poor nutrition | |
• Growth hormone deficiency | |
• Previous chemotherapy/radiotherapy | |
Metabolic syndrome | • Risk factors unknown |
• Total body irradiation probably important | |
• ?Role of growth hormone deficiency | |
• Hypothalamic dose ⩾51 Gy | |
• Physical inactivity (for example, neurological impairment) | |
• Endocrinopathy |