Endocrinopathies after allogeneic and autologous transplantation of hematopoietic stem cells

Abstract

Early and late endocrine disorders are among the most common complications in survivors after hematopoietic allogeneic- (allo-) and autologous- (auto-) stem cell transplant (HSCT). This review summarizes main endocrine disorders reported in literature and observed in our center as consequence of auto- and allo-HSCT and outlines current options for their management. Gonadal impairment has been found early in approximately two-thirds of auto- and allo-HSCT patients: 90-99% of women and 60-90% of men. Dysfunctions of the hypothalamus-pituitary-growth hormone/insulin growth factor-I axis, hypothalamus-pituitary-thyroid axis, and hypothalamus-pituitary-adrenal axis were documented as later complicances, occurring in about 10, 30, and 40-50% of transplanted patients, respectively. Moreover, overt or subclinical thyroid complications (including persistent low-T3 syndrome, chronic thyroiditis, subclinical hypo- or hyperthyroidism, and thyroid carcinoma), gonadal failure, and adrenal insufficiency may persist many years after HSCT. Our analysis further provides evidence that main recognized risk factors for endocrine complications after HSCT are the underlying disease, previous pretransplant therapies, the age at HSCT, gender, total body irradiation, posttransplant derangement of immune system, and in the allogeneic setting, the presence of graft-versus-host disease requiring prolonged steroid treatment. Early identification of endocrine complications can greatly improve the quality of life of long-term survivors after HSCT.

Figure 1

Main endocrine abnormalities after hematopoietic stem cell transplantation. Auto-HSCT and allo-HSCT: autologous- and allogeneic-hematopoietic stem cell transplantation; GnRH: gonadotropin releasing hormone; FSH: follicle-stimulating hormone; LH: luteinizing hormone; DHEA: dehydroepiandrosterone; TBI: total body irradiation; cGvHD: chronic graft-versus-host disease; ACTH: adrenocorticotropic hormone; CRH: corticotropin-releasing hormone; T4: thyroxine; T3: triiodothyronine; TSH: thyroid-stimulating hormone; TRH: thyrotropin releasing hormone. Symbol (−) means inhibition.