Normal puberty is not equal to normal gonadal function in male and female childhood cancer survivors

Abstract

Studies of gonadal function in pediatric cancer survivors have often been limited to self-reported data on menstrual function and pregnancies. Our objective was to assess puberty and gonadal function in a cohort of childhood cancer survivors through detailed history and laboratory evaluations. Retrospective chart review Childhood cancer survivors (≥10 years old) who received long-term care at WRAMC from January 1, 1985 to July 1, 2010 were identified through medical records. Survivors who started cancer treatments after 18 years of age or received gonadectomy were excluded. Detailed treatment history, puberty development including Tanner stages and testicular volume in males, as well as gynecological history in female survivors were obtained. FSH, LH, estradiol and testosterone levels were analyzed. This cohort included 39 male (age 10-21 years) and 35 female (age 10-29 years) childhood cancer survivors. Males: 100% received cancer treatments by age 16 and 79% by 12. Among 23 survivors who were treated with alkylating agents, those with abnormal puberty (n = 4) also had brain radiation or surgery. All patients with testicular failure (n = 4) received alkylating agents and/or brain radiation. Females: 98% received treatments by age 16 and 68% by 10. Abnormal puberty (n = 3) was only seen after cranial radiation. Although 60% were treated with alkylating agents, all had normal puberty and 90% had normal sex hormone profiles. Two survivors with premature ovarian failure had normal puberty; both had been treated with alkylating agents. Most childhood cancer survivors had normal puberty and sex hormone profiles in early adulthood despite gonadotoxic chemotherapy before puberty. Cranial radiation significantly increased risks for abnormal puberty and early gonadal failure. Normal puberty may not correlate with normal fertility or gonadal function later in life, and close follow-up is essential.