Endocrine Abstracts

Over the last 10 years there have been significant advances in stem cell transplantation (SCT) in adults for haematological malignancies leading to improved survival. Conditioning regimes prior to transplantation often utilise high dose chemotherapy and/or total body irradiation (TBI). Significant endocrinopathies have been reported amongst children undergoing SCT. We report the effect of SCT during adult life on endocrine function.

Basal hormone levels were obtained from 155 patients (64% male), age 20 to 67 years at a median of 36 (range 8–216) months post-transplant.

There is a high prevalence of endocrine dysfunction within this cohort. FSH concentration were elevated in all except five women of whom one was aged <45 years. In men the FSH was elevated in 83%. Testosterone deficiency was evident in 7.5% of men. Thyroid dysfunction was common; 12.9% of patients had an elevated TSH. A morning cortisol of <300 nmol/l was found in 23.2%. More patients treated with TBI had an IGF1 SDS of <−2 (15.4 vs 4.5%). Six of the eight patients who had received TBI with cranial boost had IGF1 SDS of <−2. Dyslipidaemia occurs commonly, 30% had total cholesterol over 6 mmol/l.

With the exception of low IGF1, the prevalence of these endocrine disturbances does not seem to be dependent on whether the patient had received total body or chemotherapy alone for their transplant conditioning.

These data suggest that adults undergoing SCT are at a high risk of endocrine dysfunction. More detailed studies are required to determine the severity of growth hormone deficiency and ACTH deficiency in this cohort.