The endocrine system is one of the most frequent target of complication after autologous(auto) and allogeneic(allo) hematopoietic stem cell transplantation (HSCT). We evaluated for endocrine abnormalities a retrospective cohort of 100 consecutive patients who underwent auto- (n=50) and allo- (n=50) HSCT with a median follow-up of 6 years (range, 1-15). All women experienced ovarian insufficiency; in auto- and allo-HSCT patients, serum 17betaestradiol was reduced, while in allo-HSCT delta-4-androstenedione, circulating androgens and dehydroepiandrosterone were also significantly decreased, especially in women developing graftversus- host disease (GVHD). Impaired spermatogenesis damage and lower sperm counts were observed in all transplanted patients. Testosterone was reduced in about 30% of patients, particularly during GVHD. The onset of adrenal insufficiency (about 20% of cases) was always related to the duration (>100 days) and cumulative dose (>10 gr/m2) of corticosteroid treatment. Sub-clinical hypothyroidism was found up to 5 years after allo-HSCT, with higher incidence in radiotherapy pre-treated patients, and the “low T3 syndrome” after 12-48 months and in about 30% of auto-HSCT at 3 months. Bone mass density was significantly reduced in auto- and allo-HSCT recipients and GVHD development was associated with a more severe reduction in all bone sites. The underlying diseases, pre-transplant therapies, total body irradiation and high-dose chemotherapy-based conditioning regimens were the main risk factors of endocrine disorders after auto- and allo-HSCT. Our analysis further provide evidence that auto- and allo-HSCT recipients show higher incidence of endocrine disorders suggesting that their early identification may greatly improve the quality of life of long-term survivors after HSCT.
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