当前位置:
X-MOL 学术
›
Neuroendocrinology
›
论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility.
Neuroendocrinology ( IF 4.1 ) Pub Date : 2020-04-24 , DOI: 10.1159/000508107 Emilia Sbardella 1 , Marianna Minnetti 1 , Riccardo Pofi 1 , Alessia Cozzolino 1 , Ermanno Greco 2 , Daniele Gianfrilli 1 , Andrea M Isidori 3
Neuroendocrinology ( IF 4.1 ) Pub Date : 2020-04-24 , DOI: 10.1159/000508107 Emilia Sbardella 1 , Marianna Minnetti 1 , Riccardo Pofi 1 , Alessia Cozzolino 1 , Ermanno Greco 2 , Daniele Gianfrilli 1 , Andrea M Isidori 3
Affiliation
Central hypogonadism, also defined as hypogonadotropic hypogonadism, is a recognized complication of hypothalamic-pituitary-gonadal axis damage following treatment of sellar and parasellar masses. In addition to radiotherapy and surgery, CTLA4-blocking antibodies and alkylating agents such as temozolomide can also lead to hypogonadism, through different mechanisms. Central hypogonadism in boys and girls may lead to pubertal delay or arrest, impairing full development of the genitalia and secondary sexual characteristics. Alternatively, cranial irradiation or ectopic hormone production may instead cause early puberty, affecting hypothalamic control of the gonadostat. Given the reproductive risks, discussion of fertility preservation options and referral to reproductive specialists before treatment is essential. Steroid hormone replacement can interfere with other replacement therapies and may require specific dose adjustments. Adequate gonadotropin stimulation therapy may enable patients to restore gametogenesis and conceive spontaneously. When assisted reproductive technology is needed, protocols must be tailored to account for possible long-term gonadotropin insufficiency prior to stimulation. The aim of this review was to provide an overview of the risk factors for hypogonadism and infertility in patients treated for parasellar lesions and to give a summary of the current recommendations for management and follow-up of these dysfunctions in such patients. We have also briefly summarized evidence on the physiological role of pituitary hormones during pregnancy, focusing on the management of pituitary deficiencies.
中文翻译:
鞍旁病变治疗的晚期影响:性腺机能减退和不孕症。
中枢性性腺功能减退症,也定义为低促性腺激素性性腺功能减退症,是鞍区和鞍旁肿块治疗后下丘脑-垂体-性腺轴损伤的公认并发症。除了放疗和手术外,CTLA4 阻断抗体和烷化剂(如替莫唑胺)也可通过不同的机制导致性腺功能减退。男孩和女孩的中枢性腺机能减退可能导致青春期延迟或停止,损害生殖器和第二性征的充分发育。或者,颅脑照射或异位激素的产生可能会导致青春期提前,影响对促性腺激素的下丘脑控制。鉴于生殖风险,在治疗前讨论保留生育能力的选择和转诊给生殖专家是必不可少的。类固醇激素替代疗法会干扰其他替代疗法,可能需要调整特定的剂量。充分的促性腺激素刺激疗法可使患者恢复配子发生并自然受孕。当需要辅助生殖技术时,必须调整方案以在刺激之前解决可能的长期促性腺激素不足。本综述的目的是概述接受鞍旁病变治疗的患者性腺机能减退和不孕症的危险因素,并总结目前对此类患者的这些功能障碍的管理和随访建议。我们还简要总结了垂体激素在怀孕期间的生理作用的证据,重点是垂体缺陷的管理。
更新日期:2020-04-24
中文翻译:
鞍旁病变治疗的晚期影响:性腺机能减退和不孕症。
中枢性性腺功能减退症,也定义为低促性腺激素性性腺功能减退症,是鞍区和鞍旁肿块治疗后下丘脑-垂体-性腺轴损伤的公认并发症。除了放疗和手术外,CTLA4 阻断抗体和烷化剂(如替莫唑胺)也可通过不同的机制导致性腺功能减退。男孩和女孩的中枢性腺机能减退可能导致青春期延迟或停止,损害生殖器和第二性征的充分发育。或者,颅脑照射或异位激素的产生可能会导致青春期提前,影响对促性腺激素的下丘脑控制。鉴于生殖风险,在治疗前讨论保留生育能力的选择和转诊给生殖专家是必不可少的。类固醇激素替代疗法会干扰其他替代疗法,可能需要调整特定的剂量。充分的促性腺激素刺激疗法可使患者恢复配子发生并自然受孕。当需要辅助生殖技术时,必须调整方案以在刺激之前解决可能的长期促性腺激素不足。本综述的目的是概述接受鞍旁病变治疗的患者性腺机能减退和不孕症的危险因素,并总结目前对此类患者的这些功能障碍的管理和随访建议。我们还简要总结了垂体激素在怀孕期间的生理作用的证据,重点是垂体缺陷的管理。