J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-50023 | DOI: 10.4274/jcrpe.galenos.2022.2022-2-2

The Assessment of the Hypothalamic-Pituitary-Adrenal Axis After Oncological Treatment in Pediatric Patients with Acute Lymphoblastic Leukemia

Barbara Hull¹, Anna W&281;drychowicz², Magdalena Ossowska², Aleksandra Furtak¹, Joanna Badacz², Szymon Skocze&324;³, Jerzy. B Starzyk^1
1Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University - Medical College, Cracow, Poland
²Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital, Cracow, Poland
³Department of Pediatric Oncology and Hematology, Pediatric Institute, Jagiellonian University - Medical College, Cracow, Poland

INTRODUCTION: Objective: Oncologic treatment can affect the adrenal glands, which in stressful situations may lead to life threatening adrenal crisis. The aim of the study was to assess adrenal function in pediatric acute lymphoblastic leukemia (ALL) survivors and to find best markers for this assessment.
METHODS: Methods: Forty-three ALL survivors, mean age 8.5±3.6 years and 45 age and sex-matched healthy controls were recruited to the study. ALL patients were assessed once within five years since oncological treatment completion. Fasting blood samples were collected from all participants to measure: fasting blood glucose (FBG), cortisol, aldosterone, plasma renin activity (PRA), dehydroepiandrostendione-sulfate (DHEA-S), adrenocorticotropic hormone (ACTH). Moreover, diurnal profile of cortisol levels and 24-hour urinary free cortisol (UFC) were assessed. ALL survivors underwent a test with 1 ug of the synthetic ACTH.
RESULTS: Methods: Forty-three ALL survivors, mean age 8.5±3.6 years and 45 age and sex-matched healthy controls were recruited to the study. ALL patients were assessed once within five years since oncological treatment completion. Fasting blood samples were collected from all participants to measure: fasting blood glucose (FBG), cortisol, aldosterone, plasma renin activity (PRA), dehydroepiandrostendione-sulfate (DHEA-S), adrenocorticotropic hormone (ACTH). Moreover, diurnal profile of cortisol levels and 24-hour urinary free cortisol (UFC) were assessed. ALL survivors underwent a test with 1 ug of the synthetic ACTH.
DISCUSSION AND CONCLUSION: Conclusion: Our data reflected the importance of reviewing the functionality of the adrenal glands after chemo/radiotherapy in ALL survivors. DHEA-S proved to be a good marker to assess the adrenal glands after oncological therapy. Post-treatment disturbances of the adrenal axis could be associated with metabolic complications.

Keywords: Adrenal insufficiency (AI), acute lymphoblastic leukemia (ALL), cortisol, dehydroepiandrostendione-sulfate (DHEA-S), adrenocorticotropic hormone (ACTH) test

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