"Selective" Pituitary Insufficiency Secondary to Busulfan
Authors: RAYMOND J. VIVACQUA
Journal: Annals of Internal Medicine (1967)

Case Studies1 August 1967"Selective" Pituitary Insufficiency Secondary to BusulfanRAYMOND J. VIVACQUA, M.D., FARID I. HAURANI, M.D., F.A.C.P., ALLAN J. ERSLEV, M.D., F.A.C.P.RAYMOND J. VIVACQUA, M.D.Search for more papers by this author, FARID I. HAURANI, M.D., F.A.C.P.Search for more papers by this author, ALLAN J. ERSLEV, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-2-380 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBone marrow suppression is undoubtedly the most important and common complication of busulfan therapy. However, other complications may occur, including gynecomastia (1), amenorrhea (1, 2), ovarian and testicular atrophy (3), gastrointestinal disturbances (4), diffuse interstitial pulmonary fibrosis (5, 6), hyperpigmentation of the skin (1, 7, 8), and cytologic dysplasia associated with atrophic bronchitis (9).Recently, a syndrome consisting of severe weakness, lassitude, anorexia, weight loss, and hyperpigmentation of the skin was reported to be associated with long-term busulfan (Myleran®) therapy for chronic granulocytic leukemia (4). In spite of the clinical resemblance of this syndrome to adrenal cortical insufficiency, studies of...References1. GALTONTILLWILTSHAW DAME: Busulfan (1, 4: dimethanesulfonyloxybutane), summary of clinical results. Ann. N. Y. Acad. Sci. 68: 967, 1958. CrossrefMedlineGoogle Scholar2. LOUISLIMARZIBEST JLRW: Treatment of chronic granulocytic leukemia with Myleran. Arch. Intern. Med. (Chicago) 97: 299, 1956. CrossrefGoogle Scholar3. 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WARDKONIKOVREINHARD HNNEH: Cytologic dysplasia occurring after busulfan (Myleran) therapy. A syndrome resembling adrenocortical insufficiency and atrophic bronchitis. Ann. Intern. Med. 63: 654, 1965. LinkGoogle Scholar10. ALBERT A: III. Pituitary hormones; human urinary gonadotropin. Recent Progr. Hormone Res. 12: 227, 1956. MedlineGoogle Scholar11. GLENNNELSON EMDH: Clinical method for determination of 17-hydroxycorticosteroids and 17-ketosteroids in urine following hydrolysis with β-glucuronidase. J. Clin. Endocr. 13: 911, 1953. CrossrefMedlineGoogle Scholar12. DREKTERPEARSONBARTCZAKMEGAVACK IJSETH: Rapid method for determination of total urinary 17-ketosteroids. J. Clin. Endocr. 7: 795, 1947. CrossrefGoogle Scholar13. JENKINSFORSHAMLAIDLAWREDDYTHORN DPHJCWJGW: Use of ACTH in the diagnosis of adrenal cortical insufficiency. Amer. J. Med. 18: 3, 1955. CrossrefMedlineGoogle Scholar14. LIDDLEESTEPKENDALLWILLIAMSTOWNES GWHLJWWCAW: Clinical application of a new test of pituitary reserve. J. Clin. Endocr. 19: 875, 1959. CrossrefMedlineGoogle Scholar15. MARINHOMARTINS HMPC: 1-4 Dimetanosulfoniloxibutano (G.T. 41-Myleran) na terapeutica da leucemia mieloide cronica. Arq. Brasil. Med. 46: 161, 1956. MedlineGoogle Scholar16. CASTLEMANMCNEELY BBU: Case records of the Massachusetts General Hospital. New Eng. J. Med. 272: 95, 1965. MedlineGoogle Scholar17. HARROLD BP: Syndrome resembling Addison's disease following prolonged treatment with busulphan. Brit. Med. J. 1: 463, 1966. CrossrefMedlineGoogle Scholar18. PERSSONSODERSTROM SN: Adrenocortical insufficiency in chronic leukaemia. Acta Haemat. (Basel) 27: 345, 1962. CrossrefMedlineGoogle Scholar19. DOBRINERKAPPASGALLAGHER KATF: Steroid metabolism; steroid isolation studies in human leukemia. J. Clin. Invest. 33: 1481, 1954. CrossrefMedlineGoogle Scholar20. ROBERTSWARWICK JJGP: Metabolism of Myleran (1, 4-dimethanesulfonoxybutane). Nature (London) 183: 1509, 1959. CrossrefMedlineGoogle Scholar21. ROBERTSWARWICK JJGP: Metabolic and chemical studies of "myleran": formation of 3-hydroxytetrahydrothiophene-1, 1-dioxide in vivo, and reactions with thiols in vitro. Nature (London) 184: 1288, 1959. CrossrefMedlineGoogle Scholar22. FRIESENASTWOOD HEB: Hormones of the anterior pituitary body. New Eng. J. Med. 272: 1272, 1965. CrossrefMedlineGoogle Scholar23. LERNERMCGUIRE ABJS: Melanocyte-stimulating hormone and adrenocorticotrophic hormone. Their relation to pigmentation. New Eng. J. Med. 270: 539, 1964. CrossrefMedlineGoogle Scholar24. HOFMANN K: The role of synthetic peptides in elucidation of biological problems. Metabolism (suppl.) 13: 1275, 1964. CrossrefGoogle Scholar25. NELSONANDREWS BMGA: Breast cancer and cytologic dysplasia in many organs after busulfan (myleran). Amer. J. Clin. Path. 42: 37, 1964. CrossrefMedlineGoogle Scholar26. GURELIDENHAMROOT NSWSW: Cytologic dysplasia related to busulfan (Myleran) therapy. Report of a case. Obstet. Gynec. 21: 466, 1963. Google Scholar27. BRINCK-JOHNSENSOLEMBRINCK-JOHNSENINGVALDSEN TJHKP: The 17-hydroxycorticosteroid response to corticotrophin, metopiron and bacterial pyrogen. Acta Med. Scand. 173: 129, 1963. CrossrefMedlineGoogle Scholar28. JANCHESDENDUKESSEGALDE LA BALZE MRLF: Effects of a bacterial pyrogen on the elimination of urinary 17-hydroxycorticosteroids in normal subjects. J. Clin. Endocr. 25: 17, 1965. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: RAYMOND J. VIVACQUA, M.D.; FARID I. HAURANI, M.D., F.A.C.P.; ALLAN J. ERSLEV, M.D., F.A.C.P.Affiliations: Philadelphia, PennsylvaniaFrom the Charlotte Drake Cardeza Foundation for Hematologic Research, Jefferson Medical College Hospital, Philadelphia, Pa.This study was supported by Clinical Research Center Grant FR-72 (Jefferson Medical College), National Institutes of Health, Bethesda, Md., and by Cardeza Training Grant 5212, Charlotte Drake Cardeza Foundation for Hematologic Research, Philadelphia, Pa.At the time of this study Dr. Vivacqua was a Fellow in Hematology at the Cardeza Foundation.Requests for reprints should be addressed to Allan J. Erslev, M.D., Director, Cardeza Foundation, 1015 Sansom St., Philadelphia, Pa. 19107. 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