Time course of recovery of adrenal function in children treated for leukemia

Eric I. Felner, Marita T. Thompson, Arleen F. Ratliff, Perrin C. White, Bryan A. Dickson

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Objective: Many protocols for treating children with early B-cell lineage acute lymphoblastic leukemia use 28 consecutive days of high-dose glucocorticoids during induction therapy. We prospectively studied the effects of this therapy on adrenal function. Study design: Ten children with early B-cell lineage acute lymphoblastic leukemia were evaluated by cosyntropin (corticotropin (1-24)) stimulation testing before initiation of dexamethasone therapy and every 4 weeks thereafter until adrenal function returned to normal. Results: All 10 patients had normal adrenal function before dexamethasone treatment and insufficient adrenal responses 24 hours after completing therapy. Each child felt ill for 2 to 4 weeks after completing therapy. Although 7 patients recovered normal adrenal function after 4 weeks, 3 patients did not have normal adrenal function until 8 weeks after discontinuing therapy. Statistically significant differences in both basal and corticotropin-stimulated cortisol levels were noted when comparing tests performed at baseline, 24 hours after completing therapy, and 4 weeks after completing therapy. Conclusion: High-dose dexamethasone therapy, a standard treatment for early B-cell acute lymphoblastic leukemia, can cause adrenal insufficiency lasting more than 4 weeks after cessation of treatment. This problem might be avoided by tapering doses of glucocorticoids and providing supplemental glucocorticoids during periods of increased stress.

Original languageEnglish (US)
Pages (from-to)21-24
Number of pages4
JournalJournal of Pediatrics
Volume137
Issue number1
DOIs
StatePublished - Jul 2000

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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