title: Evaluation of adrenal reserve in children with acute lymphocytic leukemia treated with prednisone or dexamethasone.
abstract: OBJECTIVE
  The purpose of this study was to compare adrenal gland reserve in acute lymphocytic leukemia (ALL) patients 8 weeks after treatment with either prednisone (PRED) or dexamethasone (DEX) during the induction phase of therapy.
  
  
  METHODS
  A double-blind comparative study of patients treated with PRED and DEX was performed. Sixteen patients received PRED (40 mg/m(2)/day) and 13 patients received DEX (6 mg/m(2)/day), both for 28 days. A low-dose adrenocorticotropic hormone test (1.0 µg/m(2), IV) was performed before and weekly for 8 weeks after abrupt cessation of glucocorticoid therapy. Sixteen children without ALL were used as controls to determine the cutoff peak cortisol level (14.2 µg/dl).
  
  
  RESULTS
  Both groups (PRED and DEX) displayed similar mean peak cortisol levels before treatment and during the 8 weeks of evaluation (p = 0.652). No relationship was observed between the incidence of infection/stress and peak cortisol level within each group, nor was there a difference in the frequency of infection/stress between groups (p = 0.359). Although the patients presented variations in peak cortisol during the study period, no signs or symptoms of adrenal insufficiency were observed.
  
  
  CONCLUSIONS
  Patients who received PRED or DEX for 4 weeks showed similar adrenal reserves and infection rates for 8 weeks after abruptly stopping glucocorticoid therapy, suggesting that DEX, which is a better antileukemic drug than PRED, has similar adrenal suppression and recovery rates.
authors.affiliation: Pediatric Endocrine Unit, Instituto da Criança, Pediatrics Department, São Paulo University Medical School, São Paulo, Brazil. hkuperman@terra.com.br
authors.forename: Hilton
authors.initials: H
authors.lastname: Kuperman
authors.forename: Vicente
authors.initials: V
authors.lastname: Odone Filho
authors.forename: Lilian Maria
authors.initials: LM
authors.lastname: Cristofani
authors.forename: Maria Tereza
authors.initials: MT
authors.lastname: Assis de Almeida
authors.forename: Nuvarte
authors.initials: N
authors.lastname: Setian
authors.forename: Durval
authors.initials: D
authors.lastname: Damiani
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D006854:Hydrocortisone