Endocrine Abstracts

Introduction: Chemotherapy may be an important cause of primary infertility, especially in girls submitted to this therapy at very young ages.

Clinical case: A 20-year-old female was diagnosed with acute lymphoblastic leukaemia at the age of 1. She was submitted to chemotherapy: intrathecal methotrexate and cyclophosphamide and i.v. doxorubicin, vincristine, mercaptopurine, asparaginase and bone marrow transplantation at the age of 2. She was referenced to Endocrine Rehabilitation Clinics at the age of 6.75 years-old. Her auxology evidenced: height 109.8 cm (p3-10); predicted adult stature: 155 cm (p10); and identical bone and chronological ages. In terms of puberty, her Tanner stages were A1P1B1. Blood analysis evidenced IGF1 of 344 ng/ml (p90) and normal thyroid and gonadal axes. At the age of 11, she remained pre-pubertal, with increased levels of FSH (76.3 mUI/ml) and LH (17.2 mUI/ml). Her bone age was 11 years. At this time, we started inducing puberty with oestradiol. After 2 years, Tanner stages were A4P4B3. Menarche was achieved at 13.41 years old. At the age of 18, she reached A5P5B5, after 7 years of estradiol+norgestrel. She withdrawal this therapy when she was 20 and scarce menses were observed. Blood tests evidenced FSH of 84.1 mUI/ml and LH of 26.7 mUI/ml and pelvic ultrasound was normal. At this age, given her desire to become pregnant, she underwent ovarian stimullation, which was unsuccessufull. However, 12 months later she became pregnant.

Discussion: This case reports the complex and not fully understood process of gonadal function after chemotherapy gonadotoxicity. We believe that the fortunate pregnancy result in our patient was probably due to previous gonadotrophins stimulation performed in a very young woman, which enabled the reactivation of the gonadic axis.