The Endocrine system is a term to describe your hormones, and an Endocrinologist is a doctor who specialises in hormones. Endocrinology covers the hormones secreted from the pituitary gland at the base of the brain, thyroid gland, parathyroid glands (on the back of the thyroid), adrenal glands (on top of your kidneys), and the gonads (testes or ovaries) (see fig. 1).
Following blood and bone marrow transplantation (BMT) endocrine problems are observed in some patients. Possible endocrine problems include:
(1) Thyroid gland dysfunction – the thyroid gland can become either over or under active. This occurs mainly in those patients who have received radiation to their neck.
(2) Thyroid nodules – after neck irradiation there is an increase risk of lumps within the thyroid gland. These can be both benign (non-cancerous) or cancerous. Because of the increased risk of cancers any lump which you can feel should be investigated.
(3) Ovarian Failure – both radiation to the ovaries and certain chemotherapy regimens can deplete the ovaries of eggs, effectively inducing an early menopause. It is important for young women to receive oestrogen replacement if this occurs to keep their bones and hearts healthy. The absence of oestrogen can cause premature osteoporosis. Egg depletion also results in sub fertility or infertility. There is more information on this website on early menopause, osteoporosis, and fertility.
(4) Testicular failure – In the testes the cells producing sperm are much more sensitive to both radiation and chemotherapy than the cells which make testosterone. After cancer therapy a man may continue to have normal levels of the male hormone testosterone, but with reduced fertility or possibly infertility. A high radiation dose directly to the testes is required to reduce testosterone levels.
(5) Bone health – vitamin D is acquired predominantly through the action of sunlight on our skin. Vitamin D deficiency is common in the normal healthy population, but is reputedly higher in cancer sufferers. This is in part because of our recommendation to use high factor sunscreens in areas previously exposed to radiation therapy. Vitamin D helps maintain bone health. There is more information on this website on vitamin D.
Osteoporosis (thin bones) is also more common in BMT survivors, particularly if oestrogen or testosterone levels are low (ovarian and testicular failure), or if prolonged high doses of steroids have been received as part of the chemotherapy regime.
(6) Pituitary failure (Hypopituitarism) – failure of the pituitary gland is seen in individuals who receive high doses of radiation to the head. The dose of radiation used for total body irradiation has not been reported to cause pituitary failure in adult survivors of BMT, though this is not uncommon in survivors of childhood BMT. Any additional radiation to the head, to treat central nervous system (CNS) involvement will increase the risk of the pituitary failing.
Who would give advice or treat hormone (endocrine) problems in Leeds?
At Leeds Teaching Hospitals Trust (LTHT) the Endocrine department has five Consultants, seven Specialist Registrars, and three Specialist Nurses. Each of the Consultants has different areas of Endocrinology in which they specialise as outlined below:
|Dr Stephen Gilbey||neuroendocrine tumours|
|Dr Robert Murray||endocrine effects of cancer therapy, pituitary disease, thyroid cancer|
|Dr Steve Orme||metabolic bone disease, pituitary disease|
|Dr Emma Ward||antenatal endocrinology|
|Dr Ramzi Ajjan||thyroid eye disease|
Endocrine problems are one of the most frequent problems that follow multi-modality cancer therapy. Adult survivors of a number of cancers are now recognised to benefit from endocrine input.
Dr Murray has worked in this sub area of endocrinology at LTHT since 2004, and prior to that at Christie Hospital in Manchester.