Evaluation of pituitary gonadotropins, gonadal steroids, spermatogenesis, and menstrual function was undertaken in 32 patients (19 males and 13 females) treated with cyclophosphamide because of nephrotic syndrome. Patients were treated before, during, or after puberty. Evaluations took place after or in very late puberty. Spermatogenic dysfunction occurred in six of 15 boys who received the entire course before and during puberty and was probably dose related. Menstrual dysfunction did not occur following treatment of six prepubertal or pubertal girls, though only low total doses were used. Therapy after puberty was associated with spermatogenic dysfunction in all four boys, but did not cause menstrual dysfunction in any of seven women. Tentative guidelines are suggested that may minimize gonadal toxicity when cyclophosphamide is used in children with nephrotic syndrome. Factors of particular importance in the interpretation of gonadotropin determinations and of sperm counts in young cyclophosphamide-treated patients are discussed.
Bibliographical noteFunding Information:
From the Departments of Pediatrics, Obstetrics and Gynecology, and Laboratory Medicine and Pathology, University of Minnesota Medical School. Supported in part by a grant (HL-O6314) from the National Institutes of Health and by contributions from the Minnesota Medical Foundation and the Mead Johnson Research Center, Evansville, indiana. *Reprint address: Department of Pediatrics, University of Minnesota Medical School, Minneapolis, M N 55455.