儿童和青少年癌症患者下丘脑-垂体-性腺轴功能的研究进展。

Jimena Lopez Dacal, Romina P Grinspon, Rodolfo A Rey
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引用次数: 1

摘要

儿童时期最常见的恶性肿瘤是白血病、脑肿瘤、淋巴瘤、神经母细胞瘤、软组织肉瘤和肾肿瘤。目前,约80%的儿童癌症可以成功治疗,这大大提高了长期生存率。与此同时,儿童癌症幸存者的成人性腺功能已成为一个关注的问题。然而,癌症的直接影响及其管理对生殖轴功能的关注较少。我们对儿童和青少年时期恶性肿瘤及其治疗对性腺轴的影响进行了综述。一些结果是有争议的,可能是因为分析没有区分恶性肿瘤类型、治疗方法和/或治疗年龄。然而,人们一致认为癌症在治疗前可以部分影响性腺功能,如低循环水平的抑制素B和抗勒氏激素。随后,化疗短暂地损害性腺的体细胞成分(即睾丸支持细胞和卵巢颗粒细胞),治疗结束后恢复正常。化疗的影响可能持续到成年后,在更密集的化疗方案,放疗和调节造血干细胞移植,当性腺或干细胞的体细胞成分严重受损。
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Review of the Function of the Hypothalamic-Pituitary-Gonadal Axis in Children and Adolescents with Cancer.

The most common malignancies in childhood are leukaemias, brain tumours, lymphomas, neuroblastomas, soft tissue sarcomas and kidney tumours. At present, about 80% of childhood cancers can be treated successfully, which has significantly increased long-term survival. Concomitantly, adult gonadal function in childhood cancer survivors has become a concern. However, the immediate effect of cancer and its management on the reproductive axis function has received less attention. We conducted a review of the effects of malignancies and their treatments on the gonadal axis during childhood and adolescence. Some results are controversial, probably because the analyses do not distinguish between the malignancy types, their treatments and/or the age at treatment. However, there is agreement that cancer can partially affect gonadal function before treatment, as revealed by low circulating levels of inhibin B and anti-Müllerian hormone. Subsequently, chemotherapy transiently impairs the somatic component of the gonads (i.e. testicular Sertoli cells and ovarian granulosa cells) with normalization after treatment ends. The impact of chemotherapy may persist through adulthood after more intensive chemotherapy regimens, radiotherapy and conditioning for haematopoietic stem cell transplantation, when there is a severe impairment of the somatic component of the gonads or of the stem germ cells.

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