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

59 Citations (Scopus)

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

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Recovery of Function
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Therapeutics
Dexamethasone
Glucocorticoids
Cosyntropin
B-Lymphocytes
Cell Lineage
Adrenal Insufficiency
Withholding Treatment
Adrenocorticotropic Hormone
Hydrocortisone

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Time course of recovery of adrenal function in children treated for leukemia. / Felner, Eric I.; Thompson, Marita T.; Ratliff, Arleen F.; White, Perrin C.; Dickson, Bryan A.

In: Journal of Pediatrics, Vol. 137, No. 1, 07.2000, p. 21-24.

Research output: Contribution to journalArticle

Felner, Eric I. ; Thompson, Marita T. ; Ratliff, Arleen F. ; White, Perrin C. ; Dickson, Bryan A. / Time course of recovery of adrenal function in children treated for leukemia. In: Journal of Pediatrics. 2000 ; Vol. 137, No. 1. pp. 21-24.
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