Gonadal Function and Puberty Assessment in a Cohort of Spanish Pediatric Survivors of Childhood Cancer

摘要

Background and Objective: Longer survival of children with cancer implies growing concern for late effects. Our aim was to investigate the prevalence of gonadal insufficiency in a cohort of Spanish pediatric cancer survivors.Patients and Methods: Childhood cancer survivors younger than 19 years were prospectively evaluated and compared with a control group of healthy children. Type of cancer and treatment, pubertal development, basal FSH, LH, testosterone, estradiol, and inhibin B were analyzed. Adolescent boys had a seminogram done, and pubertal girls a pelvic ultrasound. Results: There were 126 patients included (72 boys; 54 girls). Boys: 8% had delayed puberty. Excluding prepubertal patients, 15 (31.3%) had tubular insufficiency (small testes, elevated FSH, decreased inhibin B, and/or azoospermia), and 4 (8.3%) Leydig cell insufficiency (poor pubertal devel-opment and/or elevated LH), significantly associated with older age at treatment (X 1.226 per year) and radiotherapy (X 5.663), respectively was associated with older age at treatment. Girls: 19% had advanced/precocious puberty. Excluding prepubertal patients, 7 (16.7%) had partial ovarian insufficiency (elevated FSH and/or LH), which was significantly associated with radiotherapy (X 13.407).Conclusions: Cancer survivors should be carefully assessed during puberty, including periodic follow-up of pubertal development, FSH, LH, and inhibin B. In pubertal boys testosterone and seminogram may be very useful. In pubertal girls estradiol and ovarian ultrasound add little information to physical examination and hormonal markers.Key Words: childhood cancer, late effects, gonadal toxicity, pubertal disorders, inhibin B