Endocrine complications of pediatric stem cell transplantation

Abnormalities of endocrine function and growth are common following stem ce ll transplantation in the pediatric/adolescent population. Impaired linear growth and adult short stature are associated with younger age at transplan t, use of TBI and prior cranial irradiation, and development of chronic GvH D. Primary hypothyroidism is the most common abnormality of the thyroid and is observed in 10-28% of cases following fractionated TBI. Autoimmune hype rthyroidism has also been described post-stem cell transplant and most ofte n results from adoptive transfer of abnormal clones of T or B cells from do nor to recipient. Gonadal dysfunction is extremely prevalent and includes o ligo-azoospermia in the majority of males treated with TBI, and primary ova rian failure in most women treated with TBI or Busulfan/Cyclophosphamide. L eydig cell function, however, is retained in most males treated with standa rd forms of cytoreduction. Many patients demonstrate reduced bone mineral d ensity and are at risk of developing osteoporosis in the future.