GONADAL-FUNCTION OF YOUNG-ADULTS AFTER THERAPY OF MALIGNANCIES DURINGCHILDHOOD OR ADOLESCENCE

As the survival rate of children with malignancies has increased over past decades, the follow up of adult long-term survivors (LTS) of chil dhood cancer should focus on late effects of disease and treatment. Go nadal function was therefore studied in 54 LTS (aged 17-29 years; 33 m ale, 21 female) 2-18 years after treatment for malignancies during chi ldhood or adolescence. To analyse the sensitivity of different diagnos tic methods, tests of endocrine function (n = 52), spermiograms (n = 1 4), gynaecological status (n = 20) and ultrasonography of the gonads ( n = 53) were compared with the results of equivalent tests in 23 age-m atched normal controls (12 male, 11 female). There were no differences between male and female LTS concerning age at diagnosis, gonadal dose of irradiation (XRT) and doses of applied chemotherapeutic agents. Wh ereas male LTS had elevated levels of luteinizing hormone (LH) and fol licle-stimulating hormone (FSH) before (P < 0.05; P < 0.001) and after (P < 0.01; P < 0.001) stimulation with gonadotropin releasing hormone , female LTS exhibited normal endocrine function. Accordingly, male pa tients exhibited lower testicular volumes than normal controls, as mea sured with a Prader orchidometer (P < 0.01) or by ultrasonography (P < 0.001). Gynaecological status and ultrasonography of the gonads were normal in female LTS and controls. Whereas all spermiograms of normal controls (n = 8) showed a normal sperm cell density (SCD), only 2 of 1 4 male LTS exhibited a normal SCD (P < 0.001). Azoospermic LTS (n = 9) had been treated more often with alkylating agents and had received h igher (P < 0.05) gonadal doses of XRT. All male LTS with testicular vo lumes below the normal range (< 13 ml) and basal FSH levels above the normal range (> 10 IU/l) exhibited azoospermia, whereas LTS with norma l values for testicular volume and basal FSH had a normal SCD.