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Leydig cell failure with testicular radiation doses <20Gy: The clinical effects of total body irradiation conditioned haematopoietic stem cell transplantation for childhood leukaemia during long‐term follow‐up
Author(s) -
Taneja Surina,
Rao Anupama,
Nussey Stephen,
Leiper Alison
Publication year - 2019
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14059
Subject(s) - total body irradiation , leydig cell , testosterone (patch) , medicine , haematopoiesis , transplantation , cohort , endocrinology , retrospective cohort study , hematopoietic stem cell transplantation , stem cell , pediatrics , physiology , hormone , biology , chemotherapy , luteinizing hormone , genetics , cyclophosphamide
Objective Testosterone replacement is generally considered likely to be required only at testicular radiation doses in excess of 20Gy. Long‐term data are not available for patients receiving 9‐14.4Gy as part of Total Body Irradiation in childhood. Design Retrospective cohort study. Data collection: notes review, laboratory results, prescription of testosterone. Patients Forty‐two of 96 boys who received Total Body Irradiation (9‐14.4Gy) and Haematopoietic Stem Cell Transplantation for childhood leukaemia at Great Ormond Street Hospital between 1981‐2011 and survived >5 years. Measurements The serum concentrations of testosterone and gonadotrophins and the prescription of testosterone were recorded. Results Of the 42 boys included, 37 (88%) entered puberty spontaneously and 5 required induction. Median length of follow‐up was 19.4 years (range 5‐33.1). At last follow‐up, 23 of the 37 (62%) with spontaneous puberty were receiving testosterone replacement and 4 of the 5 (80%) with induced puberty. Conclusion This study with the benefit of long follow‐up indicates that Leydig cell failure occurs with radiation doses <20Gy. It may occur many years after irradiation and mandates long‐term screening for hypogonadism.