title: Suppression of adrenal function in children with acute lymphoblastic leukemia following induction therapy with corticosteroid and other cytotoxic agents.
abstract: OBJECTIVE
  To evaluate adrenal function in children with acute lymphoblastic leukemia (ALL) after induction therapy with corticosteroid and other cytotoxic agents. Study design Children with ALL (N=24) were treated with prednisolone (40 mg/m(2) per day) for 28 days during the induction phase followed by 1 week of oral dexamethasone every 4 weeks. A low-dose (1 microg) adrenocorticotropin (ACTH) test was performed 2 weeks after discontinuation of prednisolone; it was repeated 2 weeks later and then every 4 weeks in patients with adrenal suppression until normal response was achieved.
  
  
  RESULTS
  Adrenal suppression was found in 46% of patients at 2 weeks after discontinuation of prednisolone; it persisted in 38%, 29%, and 13% of patients through 4 weeks, 8 weeks, and 20 weeks, respectively. Adrenal suppression appeared to last significantly longer in children aged >or=5 years than in children aged <5 years. Four children developed febrile neutropenia; all belonged to the adrenal suppressed group and were unable to mount an adequate adrenal response to the stress.
  
  
  CONCLUSIONS
  About 50% of children with ALL developed adrenal suppression 2 weeks after a 4-week induction therapy with prednisolone. The suppression could persist through 20 weeks and may hinder an adequate adrenal response during acute febrile illness.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. rapmw@mahidol.ac.th
authors.forename: Pat
authors.initials: P
authors.lastname: Mahachoklertwattana
authors.forename: Soamarat
authors.initials: S
authors.lastname: Vilaiyuk
authors.forename: Suradej
authors.initials: S
authors.lastname: Hongeng
authors.forename: Chusak
authors.initials: C
authors.lastname: Okascharoen
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology; D000324:Adrenocorticotropic Hormone; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000453:epidemiology; D010913:Pituitary-Adrenal System / Q000187:drug effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011239:Prednisolone / Q000009:adverse effects*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D006854:Hydrocortisone