Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia

Gita Widyapuri; Djajadiman Gatot; Aman Bakti Pulungan; Badriul Hegar

doi:10.14238/pi54.1.2014.15-21

Gita Widyapuri Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital
Djajadiman Gatot Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital
Aman Bakti Pulungan Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital
Badriul Hegar Department of Child Health, University of Indonesia Medical School, Cipto Mangunkusumo Hospital

DOI: https://doi.org/10.14238/pi54.1.2014.15-21

Keywords: acute lymphoblastic leukemia, children, glucocorticoids

Abstract

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 Î¼ 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 Î¼g/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) Î¼g/dL and 29.29 (range 21.65 - 55 .15) Î¼g/dL, respectively. Median cortisol levels pre- and poststimulation after induction phase were 5.87 (range 0.2 - 20.53)
Î¼g/dL and 10.49 (range 0.33 - 28.69) Î¼g/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.

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