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 | |