ESPE Abstracts (2018) 89 S4.3

Management of Late Effects of Cancer Therapy

Diagnosis and Treatment of Hypogonadism in Male Survivors of Childhood Cancer

Wassim Chemaitilly


St. Jude Children’s Research Hospital, Memphis, Tennessee, USA

Gonadal dysfunction is among the most commonly reported endocrine late effects in childhood cancer survivors (CCS). The main risk factors include the exposure of the hypothalamic-pituitary-gonadal axis to radiotherapy and treatment with gonadotoxic chemotherapy drugs such as alkylating agents. Individuals may experience gonadal dysfunction because of central (or hypogonadotropic) hypogonadism or as a result of primary gonadal injury. The testes have two distinct functional entities: a reproductive compartment that consists of germ cells and their supporting system (including the Sertoli cells) and a hormone producing compartment that consists of testosterone producing Leydig cells. These compartments vary in their vulnerability to cancer treatments that target the proliferative properties of cancer cells. The rapidly multiplying germ cells are more likely to be decimated by such treatments than the more quiescent Leydig cells. Therefore, a subset of male CCS exposed to gonadotoxic treatments may experience germ cell failure and infertility despite having spontaneously progressed through puberty and maintained normal testosterone secretion during adolescence and adulthood. This presentation seeks to provide medical care providers with guidance regarding the management and treatment of central or primary hypogonadism in male CCS with emphasis on issues and challenges that are specific to this vulnerable population.

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