Abstract

PERDOMO-RAMIREZ, Iván; LINARES-BALLESTEROS, Adriana; ACEVEDO-SEDANO, Lorena  and  COLL-BARRIOS, Mauricio. Hypothalamus-pituitary-adrenal axis suppression following induction chemotherapy in children with acute lymphoblastic leukemia. Iatreia [online]. 2016, vol.29, n.1, pp.18-26. ISSN 0121-0793.  https://doi.org/10.17533/udea.iatreia.v29n1a02.

Background: Adrenal insufficiency has been reported in 46 % to 81.5 % of children receiving corticosteroids for acute lymphoblastic leukemia (ALL). Methodology: To assess the frequency of such insufficiency, 40 patients under 18 years (mean: 8.5 years) with new diagnosis of ALL were studied. Base-line cortisol and adrenocorticotropin (ACTH) levels were measured, and they received 5-week therapy with prednisolone. After 3 days off-steroid therapy, a stimulation test with ACTH 1 µg was done. In patients with abnormal cortisol (<18 µg /dL) new ACTH tests were done and cortisol levels were determined at days 7, 14 and 30 until cortisol post-stimulation levels were normal. Results: Three days after the last steroid dose 29/40 (72.5 %) had adrenal insufficiency after ACTH stimulus. At day 30 no one had abnormal cortisol levels after ACTH stimulus. All patients with adrenal suppression were over 5 years (HR 4.69; CI95 %: 1.44-15.32; p = 0.011). Conclusion: Steroids used during ALL treatment may cause adrenal insufficiency. Patients over 5 years are at high risk of developing adrenal suppression. We suggest to follow-up those patients with stress episodes after induction chemotherapy as steroid supplementation may be indicated.

Keywords : ACTH; Acute Lymphoid Leukemia; Adrenal Insufficiency; Children.

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