Endocrine and metabolic disorders in young adult survivors of childhood acute lymphoblastic leukaemia (ALL) or non-Hodgkin lymphoma (NHL)

Clin Endocrinol (Oxf). 2008 Nov;69(5):819-27. doi: 10.1111/j.1365-2265.2008.03283.x. Epub 2008 Apr 21.


Background: Treatments of acute lymphoblastic leukaemia (ALL) and non-Hodgkin lymphoma (NHL), involving various combinations of chemotherapy (chemo), cranial irradiation (CI) and/or bone marrow transplantation after total body irradiation (BMT/TBI), are often successful but may have several long-term harmful effects.

Objective: To evaluate late endocrine and metabolic complications in adult survivors of childhood ALL and NHL, in relation with the different therapeutic schemes received.

Design: Endocrine and metabolic parameters were determined in 94 patients (48 men, mean age: 24 +/- 5 years) with a former childhood ALL (n = 78) or NHL (n = 16) and subgrouped according to their previous treatment: chemo only (group I; n = 44), chemo + CI (group II; n = 32) and chemo + BMT/TBI (group III; n = 18).

Results: Severe GH deficiency (peak < 3.0 ng/ml after glucagon) was observed in 22% and 50% of patients of groups II and III, respectively, while hypothyroidism was mainly observed in group III (56%). Moreover, 83% of men developed hypogonadism after BMT/TBI, compared to 17% and 8% in groups I and II, respectively (P < 0.05), and all grafted women had ovarian failure, in contrast with other female patients in whom menarche had occurred spontaneously. Patients with BMT/TBI had also an adverse metabolic profile, with insulin resistance in 83% and dyslipidaemia in 61%.

Conclusions: This study reveals a high prevalence of endocrine and metabolic disorders in young adult survivors of childhood ALL or NHL, this frequency mainly depending on the treatment received. Treatment with BMT/TBI is the most detrimental and many of these patients will develop GHD, hypothyroidism, hypogonadism, insulin resistance and dyslipidaemia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Endocrine System Diseases / complications
  • Endocrine System Diseases / epidemiology*
  • Endocrine System Diseases / physiopathology
  • Female
  • Gonads / physiology
  • Human Growth Hormone / blood
  • Human Growth Hormone / metabolism
  • Humans
  • Insulin-Like Growth Factor I / metabolism
  • Lymphoma, Non-Hodgkin / complications
  • Lymphoma, Non-Hodgkin / epidemiology*
  • Lymphoma, Non-Hodgkin / physiopathology
  • Lymphoma, Non-Hodgkin / rehabilitation
  • Male
  • Metabolic Diseases / complications
  • Metabolic Diseases / epidemiology*
  • Metabolic Diseases / physiopathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / epidemiology*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / physiopathology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / rehabilitation
  • Prevalence
  • Signal Transduction / physiology
  • Survivors / statistics & numerical data*
  • Thyroid Gland / physiology
  • Young Adult


  • Human Growth Hormone
  • Insulin-Like Growth Factor I