46 Abstracts ingediend voor het Amsterdam Kindersymposium 2013

Glucocorticoid induced adrenal suppression in childhood acute lymphoblastic leukemia

M. Suzanne Gordijn (1), Reinoud J.B.J. Gemke (2), Marc B. Bierings (3), Cor van den Bos (4), Joost

Rotteveel (2), Gertjan J.L. Kaspers (1).

(1) Department of Pediatrics, subdivision Hematology/Oncology, VU University Medical Center, Amsterdam

(2) Department of Pediatrics, VU University Medical Center, Amsterdam

(3) Department of Pediatric Hemato/Oncology, University Medical Center Utrecht

(4) Department of Pediatric Oncology, Academic Medical Center, Amsterdam

INTRODUCTION Glucocorticoids play a major role in the treatment of acute lymphoblastic leukaemia (ALL).

However, supraphysiological doses may suppress the hypothalamic-pituitary-adrenal (HPA)

axis function, characterized by inadequately low cortisol levels, and is associated with an

impaired stress response and an inadequate defence against infections. The exact duration

of adrenal suppression and subsequent recovery during treatment for childhood ALL is

unclear.

METHODS Children aged 1-18 years that were being treated for ALL underwent a low-dose (1 μg)

ACTH stimulation test one week after the last tapering dose of a four-week induction

course of prednisone 60 mg/m2/day. In those with an impaired cortisol response, the

test was repeated until cortisol response normalized. Patients with adrenal suppression

received hydrocortisone treatment during periods of illness and stress.

RESULTS Preliminary results showed that 14 out of 24 patients (58%) had a normal adrenal function

within two weeks after prednisone treatment. Another three patients (12%) recovered wit-

hin nine weeks. Seven out of 24 patients (30%) had no recovery of their adrenal function

after approximately 14 weeks, when starting their consecutive glucocorticoid course.

CONCLUSION Adrenal insuffi ciency commonly occurs during the fi rst weeks after cessation of glucocor-

ticoid therapy for childhood ALL. Clinicians should consider prescribing glucocorticoid

replacement therapy during periods of stress in the fi rst weeks after glucocorticoid therapy,

to reduce the risk of life-threatening complications. Although the majority of patients

recover within two weeks, one third of the patients have prolonged adrenal suppression.

We currently assess possible causes and potential detection methods of prolonged adrenal

suppression in childhood ALL.