title: A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients.
abstract: OBJECTIVE
  Dexamethasone has a high therapeutic index when used to prevent chemotherapy-induced nausea and vomiting. However, the chronic use of glucocorticoids has been associated with suppression of the hypothalamic-pituitary-adrenal axis. Therefore, the authors designed this pilot study to assess the incidence of adrenal insufficiency after dexamethasone therapy as an antiemetic in cancer patients receiving chemotherapy.
  
  
  METHODS
  The rapid adrenocorticotropic hormone (ACTH) stimulation test was performed in 103 cancer patients, who had been treated with high-dose dexamethasone as an antiemetic for more than 3 months. When response to the rapid ACTH stimulation test was abnormal, the patient received corticosteroid replacement by prednisolone 7.5 mg daily for 1-2 weeks and after prednisolone replacement, changes in symptoms associated with adrenal insufficiency were investigated using a visual analog scale.
  
  
  RESULTS
  Forty-five of the 103 patients (43.7%) showed a suppressed adrenal response to the rapid ACTH stimulation test, and the incidence of adrenal suppression was found to be significantly affected by megestrol acetate use (P = 0.035). Thirty-three patients with a suppressed adrenal function achieved an improvement in quality of life after prednisolone replacement, as determined using a self-report questionnaire (22.9 ± 14.7 to 14.8 ± 11.0, P < 0.001).
  
  
  CONCLUSIONS
  We suggest that suppression of adrenal response is common after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.
authors.affiliation: Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Seongbong-ro, Heungduk-gu, Cheongju 361-711, South Korea.
authors.forename: Hye-Suk
authors.initials: HS
authors.lastname: Han
authors.forename: Young Kwang
authors.initials: YK
authors.lastname: Shim
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Jeon
authors.forename: Sung-Nam
authors.initials: SN
authors.lastname: Lim
authors.forename: Tae-Keun
authors.initials: TK
authors.lastname: Oh
authors.forename: Ki Hyeong
authors.initials: KH
authors.lastname: Lee
authors.forename: Seung Taik
authors.initials: ST
authors.lastname: Kim
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019290:Megestrol Acetate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D000932:Antiemetics; D005938:Glucocorticoids; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D019290:Megestrol Acetate