Hypothalamo-Hypophyseal-Testicular Function in Prepubertal Boys with Acute Lymphoblastic Leukemia following Chemotherapy and Testicular Radiotherapy

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Abstract
Hypothalamo-hypophyseal-testicular function was studied in 28 prepubertal boys with ALL [acute lymphoblastic leukemia] in clinical and hematological remission. Eighteen were treated with combined systemic chemotherapy (24-36 mo.) and the other 10, who had testicular leukemic infiltrates, received chemotherapy (38-60 mo.) and testicular radiotherapy (2000 rad). Plasma levels of LH [luteinizing hormone] and FSH were measured before and after stimulation with LHRH (100 .mu.g i.v.) and plasma levels of testosterone before and after stimulation with hCG [human chorionic gonadotropin] (1500 IU/48 h/7 doses). In patients treated with chemotherapy alone, mean basal LH and FSH, mean responses to LHRH stimulation and mean testosterone levels after stimulation with hCG did not significantly differ from those of the controls. Five of these patients who had normal testosterone values after 3 doses of hCG had testosterone values below the normal range after 7 doses. In patients treated with chemotherapy and testicular radiotherapy, mean basal FSH and mean responses to LHRH stimulation were significantly higher than those of the controls. Testosterone values after stimulation with hCG were low in 3 and very low in the other 7. In both groups of patients data from testicular biopsies were consistent with functional results. Chemotherapy evidently causes slight testicular damage, but chemotherapy and testicular radiotherapy produce severe testicular damage in patients with testicular leukemic infiltrates.