Article Sidebar

Submitted
26 July 2017
Accepted
26 July 2017
Published
8 August 2017
Download
PDF
Statistic
Read Counter : 929 Download : 1279

Main Article Content

Abstract

Glucocorticoids play an important role in the treatment of acute lymphoblastic leukemia (ALL). However, supraphysiological doses may cause suppression of the adrenal. Adrenal suppression resulting in reduced cortisol response may cause an inadequate host defence against infections, which remains a cause of morbidity and mortality in children with ALL. The occurrence of adrenal suppression before and after glucocorticoid therapy for childhood ALL is unclear. The aim of this study is to analysis the effect of glucocorticoid on cortisol levels during induction phase chemotherapy in children with acute lymphoblastic leukemia. A cross-sectional, observational prospective study was conducted to determine the effect of glucocorticoid on cortisol levels in children with acute lymphoblastic leukemia. Patients who met inclusion criteria were given dexamethasone or prednisone therapy for 49 days according to the 2013 Indonesian Chemotherapy ALL Protocol. Cortisol levels were measured on days 0, 14, 28, 42 and 56 of induction phase chemotherapy. There were 24 children, among 31 children recruited, who suffered from acute lymphoblastic leukemia. Before treatment, the means of cortisol levels were 228.95 ng/ml in standard risk group (prednisone) and 199.67 ng/ml in high risk group (dexamethasone). In standard risk group, the adrenal suppression occurs at about day 56. There was a significant decrement of cortisol levels in high risk group in days 14, 28, 42 against days 0 of induction phase (p=0.001). Both groups displayed different peak cortisol levels after 6 week of induction phase (p=0.028). Dexamethasone resulted in lower cortisol levels than prednisone during induction phase chemotherapy in children with acute lymphoblastic leukemia.

Keywords

glucocorticoid acute lymphoblastic leukemia cortisol levels adrenal suppression

Article Details

License

  • Folia Medica Indonesiana is a scientific peer-reviewed article which freely available to be accessed, downloaded, and used for research purposes. Folia Medica Indonesiana (p-ISSN: 2541-1012; e-ISSN: 2528-2018) is licensed under a Creative Commons Attribution 4.0 International License. Manuscripts submitted to Folia Medica Indonesiana are published under the terms of the Creative Commons License. The terms of the license are:

    Attribution ” You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

    NonCommercial ” You may not use the material for commercial purposes.

    ShareAlike ” If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.

    No additional restrictions ” You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

    You  are free to :

    Share ” copy and redistribute the material in any medium or format.

    Adapt ” remix, transform, and build upon the material.

How to Cite
Simbolon, O., Yulistiani, Y., Ugrasena, I. D., & Qibtiyah, M. (2017). ANALYSIS OF INDUCTION PHASE GLUCOCORTICOID USE ON ADRENAL SUPPRESSION IN PEDIATRIC PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA. Folia Medica Indonesiana, 52(1), 7–13. https://doi.org/10.20473/fmi.v52i1.5197
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. Ahmet A, Kim H, Spier S (2011). Adrenal suppression: a practical guide to the screening and management of this under-recognized complication of inhaled corticosteroid therapy. Allergy, Asthma & Clinical Immunology 7, 1–12
  2. Barrett E (2012). The adrenal gland. In: Walter FB & Emile LB (eds). Medical Physiology A Cellular and Molecular Approach, Philadelphia, Elsevier, p 1057–1065
  3. Christensen M, et al (2005). Treatment-related death in childhood acute lymphoblastic leukaemia in the Nordic countries: 1992-2001. British Journal of Hematology 131, 50–58
  4. Chrousos, Pavlaki AN, Magiakou MA (2011). Glucocorticoid therapy and adrenal suppression. Available from https://www.ncbi.nlm.nih.gov/books/ NBK279156/. Accessed January 15, 2015
  5. Conter V, et al (2009). Long-term results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) Studies 82, 87, 88, 91 and 95 for childhood acute lymphoblastic leukemia. Leukemia 24, 255–264
  6. Einaudi S, et al (2008). Adrenal axis function after high-dose steroid therapy for childhood acute lympho-blastic leukemia. Pediatric Blood and Cancer 50, 537–541
  7. Fauci A, Braunwald E, Kasper D (2008). Harrison's Principles of Internal Medicine 17th ed, New York, McGraw-Hill Professional
  8. Gordijn M, et al (2012). Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with gluco-corticoid therapy for childhood acute lymphoblastic leukaemia. Cochrane Database Syst Rev
  9. Kaltkas G & Alexandraki K (2012). Adrenal Suppres-sion. Available from https://www.ncbi.nlm. nih.gov/ books/NBK279047/. Accessed April 20, 2015
  10. Kuperman H, et al (2001). Evaluation of the hypothala-mic-pituitary-adrenal axis in children with leukemia before and after 6 weeks of high-dose glucocorticoid therapy. Journal of Clinical Endocrinology & Metabolism 86, 2993–2996
  11. Kuperman H, et al (2012). Evaluation of adrenal reserve in children with acute lymphocytic leukemia treated with prednisone or dexamethasone. Hormone Rese-arch in Paediatrics 78, 73–80
  12. Miller D, Brueggmeler R, Dalton J (2008). Adrenocorti-coids. In: Lemke T & Williams D (eds). Foye's Principles of Medicinal Chemistry, Philadelphia, Lippincott Williams & Wilkins, p 878–912
  13. Miller W, Achermann J, Fluck C (2008). The adrenal cortex and its disorders. In: Sperling M (ed). Pediatric Endocrinology, Philadelphia, Saunders, p 455–457
  14. Moisiadis V and Matthews S (2014). Glucocorticoid and fetal programming part 1: outcomes. Nature Review of Endocrinology 10, 391–402
  15. Prucker C, et al (2009). Induction death and treatment-related mortality in first remission of children with acute lymphoblastic leukemia: a population-based analysis of the Austrian Berlin-Frankfurt-Munster Study Group. Leukemia 23, 1264–1269
  16. Pui C, et al (2000). Long-term results of total therapy studies 11, 12 and 13A for childhood acute lympho-blastic leukemia at St Jude Children's Research Hospital. Leukemia 14, 2286–2294
  17. Rix M, et al (2005). Clinical impact of corticosteroid-induced adrenal suppression during treatment for acute lymphoblastic leukemia in children: a prospective observational study using the low-dose adrenocorticotropin study. The Journal of Pediatrics 147, 645–650
  18. Schimmer B and Funder J (2011). ACTH, adrenal steroid, and pharmacology of the adrenal cortex. In: Brunton L (ed). Goodman and Gilman's The Pharmacological Basis of Therapeutics 12th ed, New York, McGraw-Hill Comp, p 1994–1995
  19. Shulman D, Palmert M, Kemp S (2007). Adrenal insufficiency: still a cause of morbidity and death in childhood. Pediatrics 119, 484–494
  20. Silverman L, et al (2000). Results of dana-farber cancer institute consortium protocols for children with newly diagnosed acute lymphoblastic leukemia (1981-1995). Leukemia 14, 2247–2256
  21. Siswandono and Purwanto (2000). Hubungan struktur-aktivitas hormon steroid. In: Siswandono and Soekardjo B (eds). Kimia Medisinal Jilid 2, Surabaya, Universitas Airlangga Press, p 423–434
  22. Strehl C, Spies CM, Buttgereit F (2011). Pharmaco-dynamics of glucocorticoids. Clinical and Experiment-al Rheumatology 29, S13–S18
  23. Venkatesh B and Cohen J (2008). Cortisol metabolism in inflammation and sepsis. Yearbook of Intensive Care and Emergency Medicine 2008, 514–519
  24. White B (2010). The hypothalamus and pituitary gland. In: Berne and Levy (eds). Physiology 6th ed, Phila-delphia, Elsevier, p 706–724

Most read articles by the same author(s)

1 2 > >>