The Hidden Burden: Endocrinopathies in Adolescents after Hematopoietic Stem Cell Transplantation

Adolescents with malignant and nonmalignant diagnoses can require hematopoietic stem cell transplantation (HSCT), with the volume increasing 5% to 10% per annum in the United States. HSCT is an established therapy for malignancies, hemoglobinopathies, bone marrow failure, inborn errors of metabolism, and immunodeficiency. Gonadotoxic-conditioning regimens, immunosuppressive agents, and glucocorticoids are essential therapies required for a successful transplant course. Secondary endocrine sequelae can occur, however, including iatrogenic adrenal insufficiency, reduced bone mineral density, medication-induced hyperglycemia, and premature ovarian insufficiency. With broader indications for HSCT use, at-risk endocrinopathies in the post-transplant period require prompt recognition and assessment, monitoring, and medical management.