Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia
Background Glucocorticoids play an important role in the treatment ofacute lymphoblastic leukemia (ALL), but can cause side effects such as suppression of the hypothalamic-pituitaryadrenal (HPA) axis. Suppression of the HPA axis causes adrenal insufficiency, disturbs the cortisol response to stress...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Indonesian Pediatric Society Publishing House
2014-02-01
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| Series: | Paediatrica Indonesiana |
| Subjects: | |
| Online Access: | https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/163 |
| _version_ | 1818565212385574912 |
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| author | Gita Widyapuri Djajadiman Gatot Aman Bakti Pulungan Badriul Hegar |
| author_facet | Gita Widyapuri Djajadiman Gatot Aman Bakti Pulungan Badriul Hegar |
| author_sort | Gita Widyapuri |
| collection | DOAJ |
| description | Background
Glucocorticoids play an important role in the
treatment ofacute lymphoblastic leukemia (ALL), but can cause
side effects such as suppression of the hypothalamic-pituitaryadrenal (HPA) axis. Suppression of the HPA axis causes adrenal insufficiency, disturbs the cortisol response to stress, and may be a cause of morbidity and mortality in children with ALL.
Objective
To evaluate adrenal function in children with ALL after
induction chemotherapy with high dose glucocorticoids.
Methods
The adrenal function of 20 children with ALL was
evaluated using a standard dose (250 μ g) adrenocorticotropin
hormone (ACTH) test performed before and after a 6 week of
treatment with glucocorticoids induction phase chemotherapy,
which was followed by a week period tapering off. Adrenal
insuffien cy was defined as blood cortisol level of < 18 μg/dL
Results
Adrenal insufficiency was found in 14/20 subjects after
the induction phase followed by a week period of tapering off.
Median cortisol levels pre- and post-stimulation before induction
phase were 14.72 (range 2.0 1- 46. 1) μg/dL and 29.29 (range 21.65 - 55 .15) μg/dL, respectively. Median cortisol levels pre- and poststimulation after induction phase were 5.87 (range 0.2 - 20.53)
μg/dL and 10.49 (range 0.33 - 28.69) μg/dL, respectively. Clinical
signs and symptoms did not differ between those with and without
adrenal insufficiency.
Conclusion
Of 20 children with ALL, 14 develop adrenal
insufficiency after a 6-week induction therapy with glucocorticoids
and followed by a week period of tapering off. No specific clinical
signs and symptoms are identified to be related to the adrenal
insufficiency. |
| first_indexed | 2024-12-14T01:38:21Z |
| format | Article |
| id | doaj.art-73f35004479948dc857ae582093f7876 |
| institution | Directory Open Access Journal |
| issn | 0030-9311 2338-476X |
| language | English |
| last_indexed | 2024-12-14T01:38:21Z |
| publishDate | 2014-02-01 |
| publisher | Indonesian Pediatric Society Publishing House |
| record_format | Article |
| series | Paediatrica Indonesiana |
| spelling | doaj.art-73f35004479948dc857ae582093f78762022-12-21T23:21:49ZengIndonesian Pediatric Society Publishing HousePaediatrica Indonesiana0030-93112338-476X2014-02-01541152110.14238/pi54.1.2014.15-21116Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemiaGita Widyapuri0Djajadiman Gatot1Aman Bakti Pulungan2Badriul Hegar3Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo HospitalDepartment of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo HospitalDepartment of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo HospitalDepartment of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo HospitalBackground Glucocorticoids play an important role in the treatment ofacute lymphoblastic leukemia (ALL), but can cause side effects such as suppression of the hypothalamic-pituitaryadrenal (HPA) axis. Suppression of the HPA axis causes adrenal insufficiency, disturbs the cortisol response to stress, and may be a cause of morbidity and mortality in children with ALL. Objective To evaluate adrenal function in children with ALL after induction chemotherapy with high dose glucocorticoids. Methods The adrenal function of 20 children with ALL was evaluated using a standard dose (250 μ g) adrenocorticotropin hormone (ACTH) test performed before and after a 6 week of treatment with glucocorticoids induction phase chemotherapy, which was followed by a week period tapering off. Adrenal insuffien cy was defined as blood cortisol level of < 18 μg/dL Results Adrenal insufficiency was found in 14/20 subjects after the induction phase followed by a week period of tapering off. Median cortisol levels pre- and post-stimulation before induction phase were 14.72 (range 2.0 1- 46. 1) μg/dL and 29.29 (range 21.65 - 55 .15) μg/dL, respectively. Median cortisol levels pre- and poststimulation after induction phase were 5.87 (range 0.2 - 20.53) μg/dL and 10.49 (range 0.33 - 28.69) μg/dL, respectively. Clinical signs and symptoms did not differ between those with and without adrenal insufficiency. Conclusion Of 20 children with ALL, 14 develop adrenal insufficiency after a 6-week induction therapy with glucocorticoids and followed by a week period of tapering off. No specific clinical signs and symptoms are identified to be related to the adrenal insufficiency.https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/163acute lymphoblastic leukemia, children, glucocorticoids |
| spellingShingle | Gita Widyapuri Djajadiman Gatot Aman Bakti Pulungan Badriul Hegar Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia Paediatrica Indonesiana acute lymphoblastic leukemia, children, glucocorticoids |
| title | Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia |
| title_full | Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia |
| title_fullStr | Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia |
| title_full_unstemmed | Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia |
| title_short | Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia |
| title_sort | effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia |
| topic | acute lymphoblastic leukemia, children, glucocorticoids |
| url | https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/163 |
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