ENDOCRINE LATE EFFECTS IN CHILDREN WHO UNDERWENT BONE-MARROW TRANSPLANTATION - REVIEW

With the increasing use and success of BMT, larger numbers of children survive transplantation. Still, cancer treatment in children causes d amage to the endocrine glands, often inducing growth deficiency, puber tal delay and thyroid dysfunction, This paper will deal with some of t he most common endocrine disorders related to BMT in the pediatric pop ulation. Irradiation is the major contributor for growth impairment af ter BMT, acting through lesion to epiphyseal growth-plate, gonadal dam age with delayed or precocious puberty, hypothyroidism, and growth hor mone insufficiency, Gonadal dysfunction can be induced both by a direc t injury to the gonads (irradiation, gonadotoxic agents) causing prima ry hypergonadotrophic-hypogonadism, and with less frequency, by neuroe ndocrine injury to the hypothalamo-pituitary axis causing hypogonadotr opic-hypogonadism. It seems that both doses of chemotherapy and of irr adiation used by different regimens, fractionation of irradiation, and age at the time of BMT are the most important factors when we deal wi th toxic endocrine late-effects in long term survivors. In order to im prove the-quality of life of each single patient who receive BMT, and without-inflicting the success-rate of this procedure, we recommend a life-long surveillance to prevent or to treat symptoms and disorders c aused by hormone deficiencies, and we also advocate for a multidiscipl inary team-approach that includes an endocrinologist consultant.