Abstract
Leydig cell insufficiency is a frequent complication of bilateral TI with 24 gy (NEJM 1983). To describe the long term follow-up and the testosterone (T) deficiency we studied, with an interval time since TI >2yrs, 28 boys irradiated with 12X2Gy at 4.8 to 16.9 yrs, before (24) or during (4) puberty. All but 4 received also cranial prophylactic irradiation. All but the 2 olders at TI had leydig cell insufficiency manifested by a low T response to hCG (7×1500U) and/or by increased basal plasma LH (>5mIU/ml) when bone age (BA) >12yrs (n=21). The 8 patients with normal (2) or compensated (6) T secretion had normal spontaneous virilisation with T between 4.3 and 8 ng/ml. This group included all the boys irradiated during puberty. Age at TI and T/hCG were highly correlated (n=21, r=0.62, p<0.001). In 6 cases, a 2nd hCG test performed at intervals from 0.6 to 5.5yrs, showed a response identical to the 1st test (r=0.99). Similarly in 8 cases having a 2nd evaluation after >2yrs, when BA>12yrs and LH>5mIU/ml, a correlation was found between basal T and prepubertal T response to hCG (r=0.79, p<0.01).
In conclusion 1) The severity of leydig cell insufficiency is highly related to age at testicular irradiation. 2) No significant change from the initial evaluation was observed on follow-up. 3) Spontaneous pubertal virilisation may occur and was usually permitted by compensated T insufficiency.
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Brauner, R., Caltabiano, P., Rappaport, R. et al. 6 TESTICULAR IRRADIATION (TI) FOR ACUTE LYMPHOBLASTIC LEUKEMIA (ALL): LONG TERM FOLLOW-UP OF LEYDIG CELL FUNCTION AND PUBERTAL DEVELOPMENT. Pediatr Res 24, 518 (1988). https://doi.org/10.1203/00006450-198810000-00027
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DOI: https://doi.org/10.1203/00006450-198810000-00027