Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 91

Late endocrine effects of allogeneic‐HCT usually occur as a result of radiation, chemotherapy, or due to cGVHD treatments [39, 77]. Organs commonly involved include the thyroid gland, gonads, and pancreatic islets. Despite frequent exposures to corticosteroid therapies, the HCT recipients generally have a low incidence of hypoadrenalism. The major risk factor for hypothyroidism is TBI. The median time of occurrence of hypothyroidism is 4 years post‐HCT. Annual screening with biochemical markers is suggested. A 3.65 times higher incidence of diabetes mellitus (DM) compared with matched siblings has been reported in allogeneic‐HCT recipients [40]. At two years post‐HCT, up to one‐third of patients may develop DM [41], thereby suggesting a role for screening for DM at annual intervals. The development of DM itself may accelerate the rate of other known complications, including cataracts and chronic kidney disease.