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Eur J Pediatr. 2020 Mar 17. doi: 10.1007/s00431-020-03624-5. [Epub ahead of print]

Adrenal function after induction therapy for acute lymphoblastic leukemia in children short: adrenal function in ALL.

Author information

1
New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029HUS, Helsinki, Finland.
2
New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029HUS, Helsinki, Finland. mervi.taskinen@hus.fi.

Abstract

Prednisolone used in the induction phase of the treatment of acute lymphoblastic leukemia (ALL) may suppress hypothalamic-pituitary-adrenal axis and require hydrocortisone substitution. In this retrospective analysis, we reviewed altogether 371 ACTH stimulation tests of 352 children after a uniform NOPHO (Nordic Society of Pediatric Hematology and Oncology) ALL induction. Both low- and standard-dose ACTH tests were used. Full recovery of adrenal function was defined by both normal basal and stimulated cortisol levels. Sixty-two percent of patients were detected with normal adrenal function in median of 15 days after tapering of prednisolone. Both low basal and stimulated cortisol levels were detected in 13% of patients. The median time to normal adrenal function was 31 days (95% CI 28-34), 24 days (95% CI 18-30), and 12 days (95% CI 10-14) for those with basal cortisol <107, 107-183, and >183 nmol/L at first ACTH testing, respectively. Patients with fluconazole prophylaxis had higher median baseline cortisol levels compared to patients without prophylaxis (207 nmol/L, range 21-839 nmol/L vs. 153 nmol/L, range 22-832 nmol/L, P = 0.003).Conclusion: These data can be used to reduce unnecessary substitution or testing, but also to guarantee hydrocortisone substitution for those at risk.What is Known:•These data can be used to reduce unnecessary hydrocortisone substitution or ACTH testing.•Our data helps to guarantee hydrocortisone substitution for those at risk of adrenal insufficiency.What is New:•Full recovery of adrenal function after ALL induction is detected in 62% of patients already at 15 days after tapering of prednisolone.•Both basal and stimulated cortisol testing are required for detection of full adrenal recovery.•Recovery time of adrenal function is extended over 3-4 weeks after tapering of prednisolone in patients with low basal cortisol levels (<107 nmol/L) at first testing.

KEYWORDS:

ACTH testing; Acute lymphoblastic leukemia; Adrenal insufficiency; Prednisolone

PMID:
32193656
DOI:
10.1007/s00431-020-03624-5

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