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The Scientific World Journal
Volume 2014, Article ID 282147, 13 pages
http://dx.doi.org/10.1155/2014/282147
Review Article

Endocrinopathies after Allogeneic and Autologous Transplantation of Hematopoietic Stem Cells

1Department of Sports Science and Wellness, University “Parthenope” Naples, 80133 Naples, Italy
2Sterile Techniques SSD, AOU “S. Giovanni di Dio e Ruggi d’Aragona” Salerno, Salerno, Italy
3Department of Clinical Medicine and Surgery, University Federico II Naples, 80131 Naples, Italy
4Unit of Obstetrics and Gynaecology, “Arcispedale Santa Maria Nuova”, IRCCS, 42123 Reggio Emilia, Italy
5Hematology and Hematopoietic Stem Cell Transplant Center, Department of Medicine and Surgery, University of Salerno, 84131 Salerno, Italy

Received 17 December 2013; Accepted 22 January 2014; Published 30 April 2014

Academic Editors: P. Campiglia, G. Iaccarino, M. Illario, and N. Montuori

Copyright © 2014 Francesco Orio et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.