Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 137

Exposure‐related gonadal toxicity may cause infertility in children and adults. However, whereas gonadal hormonal insufficiency causes premature menopause and, less commonly, early andropause, children can experience delayed puberty, failure to develop secondary sexual characteristics, and failure to achieve normal adult bone mass. Underlying diagnoses like thalassemia, sickle cell disease, FA, DBA, DC are at greater risk due to endocrinopathies associated with iron‐overload. In boys, Leydig cells are less sensitive to damage than spermatogonia. In prepubertal girls, hormonal function and fertility are equally impaired, and primary ovarian insufficiency is very common after myeloablative busulfan in post‐pubertal girls. Age‐appropriate monitoring of gonadotropin and gonadal hormone levels is usual and some endocrinologists find the anti‐Mullerian hormone level to be a helpful indicator of ovarian reserve.