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Related Experiment Videos

Changes in hypothalamic-pituitary function following bone marrow transplantation in children

C Kubota1, O Shinohara, T Hinohara

  • 1Department of Pediatrics, Tokai University School of Medicine, Kanagawa-ken, Japan.

Acta Paediatrica Japonica : Overseas Edition
|February 1, 1994
PubMed
Summary

Bone marrow transplantation (BMT) can impair pituitary function in children, often causing transient hypothyroidism and gonadal issues, particularly in pubertal patients. Protecting the gonads during irradiation is recommended to prevent hypogonadism.

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Area of Science:

  • Pediatric Endocrinology
  • Hematology
  • Oncology

Background:

  • Bone marrow transplantation (BMT) is a common treatment for various pediatric conditions.
  • Preparative irradiation used in BMT can lead to significant endocrine dysfunction, particularly affecting the pituitary gland.
  • Previous assessments of pituitary function post-BMT have lacked detailed, longitudinal data.

Purpose of the Study:

  • To precisely assess pituitary function in children following bone marrow transplantation (BMT) using repeated provocative testing.
  • To evaluate the incidence and nature of pituitary dysfunction, including thyroid and gonadal axes, after BMT.
  • To identify potential risk factors and recommend preventive strategies for endocrine sequelae.

Main Methods:

  • Studied 32 children (16 boys) who underwent BMT with preparative irradiation.

Related Experiment Videos

  • Performed serial pituitary function assessments using insulin, luteinizing hormone-releasing hormone (LHRH), and thyrotropin-releasing hormone (TRH) provocative tests.
  • Monitored serum levels of free thyroxine (FT4), thyrotropin (TSH), gonadotropins, and assessed Leydig cell function via human chorionic gonadotropin (hCG) testing.

    • Main Results:

    • Transient hypothyroidism was observed in the early post-BMT period, with subnormal TSH response to TRH in 8/29 patients, but no overt hypothyroidism requiring therapy.
    • Elevated basal and peak gonadotropin levels in response to LHRH were noted in pubertal patients, indicating potential gonadal failure, despite normal Leydig cell function.
    • Pituitary-adrenal function and prolactin secretion remained unaffected; three girls achieved menarche, and one male fathered a child 7 years post-BMT.

    Conclusions:

    • Children undergoing BMT frequently experience transient hypothyroidism and a high incidence of gonadal failure, especially those treated around puberty.
    • Repeated provocative testing is crucial for accurate assessment of pituitary function post-BMT.
    • Shielding of gonads during preparative irradiation should be considered to mitigate the risk of hypogonadism.