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Ann Pediatr Endocrinol Metab > Volume 11(2); 2006 > Article
Puberty and Gonadal Function after Bone Marrow Transplantation During Childhood.
Kyung Hwa Ha, Min Ho Jung, Nak Gyun Chung, Bin Cho, Byung Kyu Suh, Hak Ki Kim, Byung Churl Lee
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. jmhpe@catholic.ac.kr
Abstract
PURPOSE
Bone marrow transplantation (BMT) involving high dose chemotherapy and irradiation can seriously affect the gonad and reproductive axis. We studied puberty and gonadal function in the subjects who underwent BMT during childhood for the treatment of acute leukemia. METHODS: 25 females (age at examination:15.7+/-3.1 years; age at BMT:10.3+/-3.0 years) and 22 males (age at examination:16.4+/-2.0 years; age at BMT:11.1+/-2.2 years) who underwent BMT for acute leukemia were included. We evaluated their pubertal status and gonadal function before and after BMT, and investigated the clinical factors influencing disturbances of gonadal function in these patients.
RESULTS
Of the 13 females who were prepubertal before BMT, two had no breast development by 13 years of age, and the others entered puberty spontaneously. Of the 8 females who were older than 16 years at the last evaluation, 5 had primary amenorrhea, and 3 developed secondary amenorrhea. Sixteen (64.0%) out of 25 pubertal females had abnormally elevated serum concentrations of luteinizing hormone (LH), and 23 (92.0%) had abnormally elevated serum concentrations of follicle-stimulating hormone (FSH). Abnormal elevation of LH was more frequent in the females who had entered puberty at BMT compared with those before puberty (91.7% vs 45.5%, OR=13.2, P<0.05). Of the 19 males who were prepubertal before BMT, 3 did not enter puberty spontaneously by 14 years of age, and the others entered puberty spontaneously. Four (18.2%) out of 22 pubertal males had abnormally elevated plasma concentrations of LH, and 9 (42.9%) had abnormally elevated plasma concentrations of FSH. Abnormal elevation of FSH was more frequent in males who underwent BMT after relapse than those without relapse (87.5% vs 20.0%, OR=28.0; P<0.05).
CONCLUSION
More than 40% of the girls who underwent BMT cannot retain adequate ovarian function to complete puberty and menstruate regularly. The ovaries of the pubertal girls seem to be more vulnerable to BMT. The majority of the boys experience normal pubertal development after BMT, but about 40% of the boys had abnormally elevated levels of FSH, which is indicative of germ cell dysfunction.
Keywords: Puberty;Gonad;Bone marrow transplantation;Childhood
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