Plasma gonadotropins and gonadal steroids in children treated with cyclophosphamide

Abstract

Twelve boys (4.7 to 15.4 years) and five girls (4.3 to 14.1 years) treated with cyclophosphamide, 50 to 100 mg/day for periods of two to 12 months were studied. Plasma follicle-stimulating hormone, luteinizing hormone, Δ 4 -androstenedione, testosterone, 17β-estradiol, 17-hydroxyprogesterone, and progesterone were determined by radioimmunoassay in four to six samples from each patient. At time of the study, cyclophosphamide had not been given for 1.0 to 5.3 years. Results were compared to age-matched healthy boys and girls. Four boys treated when prepubertal had a normal hormonal profile. Three out of seven boys treated during stage II of puberty had elevated FSH and LH levels, low Δ 4 -androstenedione levels, but normal plasma testosterone (0.9 to 2.7 years after therapy). Follow-up studies in two of these three boys (4.0 and 6.1 years, respectively, after therapy) disclosed azzospermia in one and severe oligospermia in the other; each had elevated plasma FSH concentrations. In the remaining four boys of this group with previously normal hormonal profiles, follow-up studies in three of them (4.0 to 7.9 years after cyclophosphamide therapy) disclosed normal sperm counts and plasma FSH in one boy and mild oligospermia with normal plasma concentration in two. No evidence of primary ovarian failure was detected in any of the girls. It is suggested that caution should be maintained not only in the total dose and duration of cyclophosphamide therapy, but also in the degree of pubertal development at time of initial therapy.