Search tips
Search criteria 


Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. 1992 September; 67(9): 1107–1110.
PMCID: PMC1793609

Endocrine deficit after fractionated total body irradiation.


Endocrine function was assessed in 31 children (17 boys) after fractionated total body irradiation used in the preparative regimen for bone marrow transplantation. Endocrine dysfunction was present in 25 children. Fifteen of 29 had growth hormone insufficiency 0.9-4.9 years after total body irradiation, yet only three of the 15 had received previous cranial irradiation. Five of 30 had thyroid dysfunction: two with a low thyroxine and raised thyroid stimulating hormone (TSH) concentration and three with a raised TSH and normal thyroxine concentration. Thus the incidence of thyroid dysfunction (16%) is much lower than that reported after single fraction total body irradiation (39-59%). In only two children were abnormalities of the hypothalamic-pituitary-adrenal axis demonstrated. The majority of pubertal children assessed (n = 15) showed evidence of gonadal damage. All the pubertal girls (n = 5) had ovarian failure, although there was evidence of recovery of ovarian function in one girl. All seven boys in late puberty showed evidence of damage to the germinal epithelium, and two of three in early puberty had raised follicle stimulating hormone concentrations. Despite the use of a fractionated total body irradiation regimen, endocrine morbidity is substantial and children undergoing such procedures will require long term endocrine review and management.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (719K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Birch JM, Marsden HB, Jones PH, Pearson D, Blair V. Improvements in survival from childhood cancer: results of a population based survey over 30 years. Br Med J (Clin Res Ed) 1988 May 14;296(6633):1372–1376. [PMC free article] [PubMed]
  • Littley MD, Shalet SM, Morgenstern GR, Deakin DP. Endocrine and reproductive dysfunction following fractionated total body irradiation in adults. Q J Med. 1991 Mar;78(287):265–274. [PubMed]
  • Leiper AD, Stanhope R, Lau T, Grant DB, Blacklock H, Chessells JM, Plowman PN. The effect of total body irradiation and bone marrow transplantation during childhood and adolescence on growth and endocrine function. Br J Haematol. 1987 Dec;67(4):419–426. [PubMed]
  • Sanders JE, Pritchard S, Mahoney P, Amos D, Buckner CD, Witherspoon RP, Deeg HJ, Doney KC, Sullivan KM, Appelbaum FR, et al. Growth and development following marrow transplantation for leukemia. Blood. 1986 Nov;68(5):1129–1135. [PubMed]
  • Zachmann M, Prader A, Kind HP, Häfliger H, Budliger H. Testicular volume during adolescence. Cross-sectional and longitudinal studies. Helv Paediatr Acta. 1974 Apr;29(1):61–72. [PubMed]
  • Shalet SM, Beardwell CG, Twomey JA, Jones PH, Pearson D. Endocrine function following the treatment of acute leukemia in childhood. J Pediatr. 1977 Jun;90(6):920–923. [PubMed]
  • Peters L. Total Body Irradiation Conference: discussion: the radiobiological bases of TBI. Int J Radiat Oncol Biol Phys. 1980 Jun;6(6):785–787. [PubMed]
  • Hendry JH. Response of human organs to single (or fractionated equivalent) doses of irradiation. Int J Radiat Biol. 1989 Nov;56(5):691–700. [PubMed]
  • Borgström B, Bolme P. Growth and growth hormone in children after bone marrow transplantation. Horm Res. 1988;30(2-3):98–100. [PubMed]
  • Clayton PE, Shalet SM. Dose dependency of time of onset of radiation-induced growth hormone deficiency. J Pediatr. 1991 Feb;118(2):226–228. [PubMed]
  • Katsanis E, Shapiro RS, Robison LL, Haake RJ, Kim T, Pescovitz OH, Ramsay NK. Thyroid dysfunction following bone marrow transplantation: long-term follow-up of 80 pediatric patients. Bone Marrow Transplant. 1990 May;5(5):335–340. [PubMed]
  • Sklar CA, Kim TH, Ramsay NK. Thyroid dysfunction among long-term survivors of bone marrow transplantation. Am J Med. 1982 Nov;73(5):688–694. [PubMed]
  • Best JD, Alford FP, Donald RA. Evaluation of the three hour metyrapone test in adults. Clin Endocrinol (Oxf) 1980 Jul;13(1):69–76. [PubMed]
  • Wallace WH, Shalet SM, Hendry JH, Morris-Jones PH, Gattamaneni HR. Ovarian failure following abdominal irradiation in childhood: the radiosensitivity of the human oocyte. Br J Radiol. 1989 Nov;62(743):995–998. [PubMed]
  • Shalet SM. Gonadal function following radiation and cytotoxic chemotherapy in childhood. Ergeb Inn Med Kinderheilkd. 1989;58:1–21. [PubMed]
  • Sklar CA, Kim TH, Ramsay NK. Testicular function following bone marrow transplantation performed during or after puberty. Cancer. 1984 Apr 1;53(7):1498–1501. [PubMed]
  • Ash P. The influence of radiation on fertility in man. Br J Radiol. 1980 Apr;53(628):271–278. [PubMed]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group