Endocrine Abstracts

Background: Over the last 20 years there have been significant advances in stem cell transplantation (SCT) in adults for haematological malignancies leading to improved survival. Endocrine disorders are among the most common complications in survivors after hematopoietic allogeneic stem cell transplant (HSCT), but data on adult transplant patients are still scarce.

Methods: This is a retrospective study which included 284 adult patients (94 females and 190 males) who underwent allogeneic HSCT between 2002 and 2014 in a University Irish Hospital. All patients were preconditioned with chemotherapy and total body irradiation (TBI). One hundred and thirty four patients received allogeneic HSCT from unrelated donors. The functions of the hypothalamic-pituitary-gonadal/thyroid/adrenal/somatotroph axis were evaluated at time of last review.

Results: The mean age of the patients at diagnosis was 33.3 (S.D.±10.6) years old with a mean age at transplant of 35.2 (S.D.±10.3) years old. 11.3% of the patients tested (n=44) had low morning cortisol levels at 16 months post-transplant and 25% of the patients tested (n=12) had hyperprolactinemia at 6 months post-transplant. Insulin-like growth factor-1 was tested in only 13 patients with below the normal range value in one patient (7.6%) and above normal range values in 2 patients (15.2%). Beyond one-year post - transplant, 39% of the patients had abnormal thyroid function tests of which 15% (n=10) displayed biochemical features of central hypothyroidism. Out of 54 women tested, 8 (14.8%) displayed biochemical features of hypogonadotropic hypogonadism and 33 (61.1%) had hypergonadotropic hypogonadism. In males, out of 108 tested, 2 (1.8%) had hypogonadotropic hypogonadism and 67 (62%) had hypergonadotropic hypogonadism. Out of 104 patients tested, 21.1%had a raised sex hormone binding globulin (SHBG). Men were more likely than women to develop hypergonadotropic hypogonadism (P<0.01). Patients with normal LH and FSH were more likely to be older compared to patients with a raised LH and FSH (35.9 Vs 31.5 years old, P<0.01). SHBG was more likely to be raised in patients with raised LH and FSH (P<0.01). Oestradiol levels but not testosterone levels were more likely to be influenced by age (P=0.01 vs P=0.1).

Conclusion: These data suggest that adults undergoing HSCT are at a high risk of endocrine dysfunction. These patients require early endocrinology input and long-term surveillance for the detection and treatment of endocrine disorders.