Hypogonadism Risk in Men Treated for Childhood Cancer

Romerius, Patrik; Ståhl, Olof; Maaser, Christian; Relander, Thomas; Cavallin‐Ståhl, Eva; Wiebe, Thomas; Giwercman, Yvonne Lundberg; Giwercman, Aleksander

doi:10.1210/jc.2009-0337

Cited by 82 publications

(55 citation statements)

References 30 publications

(38 reference statements)

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“…64 Given the potential morbidity associated with this complication and the availability of effective treatments, continuation of this screening may be prudent. 65 The prevalence of Leydig cell dysfunction in childhood cancer survivors has ranged from 2% to 23%, [66][67][68][69] lower than the prevalence identified in our study (32%). This may reflect the higher proportion of at-risk patients with a history of HCT (52%) in our cohort, a large proportion of whom received testicular irradiation (48%), and the fact that our cohort included only those at risk for the complication because of gonadotoxic therapeutic exposure.…”

Section: -56contrasting

confidence: 55%

Yield of Screening for Long-Term Complications Using the Children's Oncology Group Long-Term Follow-Up Guidelines

Landier

Armenian

Liu

et al. 2012

JCO

114

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PurposeThe Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines use consensus-based recommendations for exposure-driven, risk-based screening for early detection of long-term complications in childhood cancer survivors. However, the yield from these recommendations is not known.MethodsSurvivors underwent COG-LTFU Guideline–directed screening. Yield was classified as negligible/negative (< 1%), intermediate (≥ 1% to < 10%), or high (≥ 10%). For long-term complications with high yield, logistic regression was used to identify subgroups more likely to screen positive.ResultsOver the course of 1,188 clinic visits, 370 childhood cancer survivors (53% male; 47% Hispanic; 69% leukemia/lymphoma survivors; median age at diagnosis, 11.1 years [range, 0.3 to 21.9 years]; time from diagnosis, 10.5 years [range, 5 to 55.8 years]) underwent 4,992 screening tests. High-yield tests included thyroid function (hypothyroidism, 10.1%), audiometry (hearing loss, 22.6%), dual-energy x-ray absorptiometry scans (low bone mineral density [BMD], 23.2%), serum ferritin (iron overload, 24.0%), and pulmonary function testing/chest x-ray (pulmonary dysfunction, 84.1%). Regression analysis failed to identify subgroups more likely to result in high screening yield, with the exception of low BMD (2.5-fold increased risk for males [P = .04]; 3.3-fold increased risk for nonobese survivors [P = .01]). Screening tests with negligible/negative (< 1%) yield included complete blood counts (therapy-related leukemia), dipstick urinalysis for proteinuria and serum blood urea nitrogen/creatinine (glomerular defects), microscopic urinalysis for hematuria (hemorrhagic cystitis, bladder cancer), ECG (anthracycline-related conduction disorder), and hepatitis B and HIV serology.ConclusionScreening tests with a high yield are appropriate for risk groups targeted for screening by the COG-LTFU Guidelines. Elimination of screening tests with negligible/negative yield should be given consideration.

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Section: -56contrasting

confidence: 55%

Yield of Screening for Long-Term Complications Using the Children's Oncology Group Long-Term Follow-Up Guidelines

Landier

Armenian

Liu

et al. 2012

JCO

114

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“…In a similar study of 32 male CLSs Romerius et al [19] showed a prevalence of hypogonadism of 31% (10 of 32) compared to 4% in healthy controls. In a study of adult lymphoma survivors with a median age of 33 years at diagnosis, the prevalence was 31% [4].…”

Section: Discussionmentioning

confidence: 84%

Gonadal function and parenthood 20 years after treatment for childhood lymphoma: A cross‐sectional study

Hamre

Kiserud

Ruud

et al. 2011

Pediatric Blood & Cancer

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BackgroundGonadal function decades after treatment for childhood lymphoma (CL) is not well described. This cross‐sectional study had two aims: (1) describe long‐term gonadal function and fertility in childhood lymphoma survivors (CLSs), and (2) explore anti‐Mullerian hormone (AMH) as a measure of ovarian function in CLSs.ProcedureSeventy‐four male and 62 female CLSs participated in a survey consisting of a questionnaire, clinical examination, and blood/semen analysis. Prior treatment was categorized according to gonadotoxicity. Hypogonadism was determined by levels of gonadal hormones based on luteinizing hormone, follicle‐stimulating hormone, testosterone (males), AMH (females <40 years), and menstrual status. Fertility was explored according to pregnancies achieved, semen analysis, and AMH.ResultsHypogonadism was observed in 7 of 66 males (11%). Seven of 64 males (11%) were categorized as infertile. Nine of 45 females <40 years (20%) were at risk to develop premature ovarian failure (POF). Twenty of 45 females (44%) showed low‐AMH levels indicating decreased fertility. Four “critically low” females reported pregnancies within the preceding 2 years. Sixty‐four percent of the males and 93% of the females attempting parenthood had been successful (P = 0.01). Hypogonadism and low‐AMH were related to treatment burden.ConclusionTwenty years after treatment of CL, female CLSs' attempts of pregnancy initiation are mostly successful, while males seem at higher risk of infertility. Hypogonadism is a problem in 10% of the male CLSs. Based on AMH levels, POF is a risk in 20% of the female CLSs. The clinical significance of AMH reflecting true probability of fertility needs further research in cancer survivors. Pediatr Blood Cancer 2012;59:271–277. © 2011 Wiley Periodicals, Inc.

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“…Nonetheless, Leydig cell dysfunction may be observed following treatment with alkylating agent regimens, with some reports indicating that from 10 to 57% of male subjects can develop elevated serum concentrations of LH following treatment (Bramswig et al 1990, Siimes et al 1995, Heikens et al 1996, Mackie et al 1996, Papadakis et al 1999, Sklar 1999, Relander et al 2000, Kenney et al 2001, Romerius et al 2009). When it does occur, chemotherapy-induced Leydig cell dysfunction is generally subclinical (Afify et al 2000, Bakker et al 2004, Sanders 2004.…”

Section: Leydig Cell Dysfunctionmentioning

confidence: 99%

Endocrine complications in long-term survivors of childhood cancers

Chemaitilly

Sklar²

2010

Endocrine-Related Cancer

185

149

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Endocrine disturbances are among the most frequently reported complications in childhood cancer survivors, affecting between 20 and 50% of individuals who survive into adulthood. Most endocrine complications are the result of prior cancer treatments, especially radiotherapy. The objective of the present review is to discuss the main endocrine complications observed in this population, including disorders of the hypothalamic-pituitary axis, disorders of pubertal development, thyroid dysfunction, gonadal dysfunction, decreased bone mineral density, obesity, and alterations in glucose metabolism with a special focus on recent findings reported from the Childhood Cancer Survivor Study.

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Hypogonadism Risk in Men Treated for Childhood Cancer

Abstract: Adult male survivors of childhood cancer are at risk of hypogonadism, which should be acknowledged in the long-term follow-up of these men.

Cited by 82 publications

References 30 publications

Yield of Screening for Long-Term Complications Using the Children's Oncology Group Long-Term Follow-Up Guidelines

Yield of Screening for Long-Term Complications Using the Children's Oncology Group Long-Term Follow-Up Guidelines

Gonadal function and parenthood 20 years after treatment for childhood lymphoma: A cross‐sectional study

Endocrine complications in long-term survivors of childhood cancers

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