Hypothalamic-pituitary-adrenal axis function in survivors of childhood acute lymphoblastic leukemia and healthy controls

Gordijn, Maartje S.; Litsenburg, Raphaële R. van; Gemke, Reinoud J. B. J.; Bierings, Marc; Hoogerbrugge, Peter M.; Ven, Peter M. van de; Heijnen, Cobi J.; Kaspers, Gertjan J. L.

doi:10.1016/j.psyneuen.2012.01.014

Cited by 24 publications

(11 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors reported higher salivary cortisol levels and increased cortisol suppression in ALL patients following oral dexamethasone, and an elevated level of cortisol was associated with more fatigue and poorer HRQoL. (Gordijn et al,2012) Corticosteroid is an important component in contemporary protocols. Future studies should evaluate the delicate interrelations among high-dose corticosteroid exposure during the active treatment phase, changes in cortisol levels in response to stress and their effects on neurocognitive and behaviorial outcomes in long-term ALL survivors.…”

Section: Discussionmentioning

confidence: 99%

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

Cheung

Krull

2015

Neuroscience & Biobehavioral Reviews

143

145

View full text Add to dashboard Cite

The intensified administration of chemotherapeutic drugs has gradually replaced cranial radiation therapy (CRT) for the treatment of childhood acute lymphoblastic leukemia (ALL). While CRT is often implicated in neurocognitive impairment in ALL survivors, there is a paucity of literature that evaluates the persistence of neurocognitive deficits in long-term survivors of pediatric ALL who were treated with contemporary chemotherapy-only protocols. Results from this systematic review concurred to the probable cognitive-sparing effect of chemotherapy-based protocols over CRT in long-term survivors. However, coupled with multiple intrinsic and extrinsic factors, survivors who received chemotherapy treatment still suffered from apparent cognitive impairment, particularly in the attention and executive function domains. Notably, there is evidence to suggest that the late neurotoxic effect of methotrexate on survivors’ neurocognitive performance may be dose-related. This review also recommends future pharmacokinetic, neuroimaging and genetic studies to illuminate the multifactorial nature of this subject matter and discusses the potential value of neurochemical, physiological, inflammatory and genetic markers for the prediction of susceptibility to neurocognitive impairment in long-term survivors of childhood ALL.

show abstract

Section: Discussionmentioning

confidence: 99%

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

Cheung

Krull

2015

Neuroscience & Biobehavioral Reviews

143

145

View full text Add to dashboard Cite

show abstract

“…The mechanism of insult can be the space-occupying tumor itself, or from treatment with cranial radiation, intrathecal chemotherapy, or surgery. Sleep disturbances can also result from neuroendocrine function secondary to insult to the hypothalamic-pituitary-adrenal axis (Gordijn et al, 2012). Side effects of various medications used in cancer therapy, particularly dexamethasone and other pain medications, have sedating effects and are associated with insomnia and resulting excessive daytime sleepiness (Vallance et al, 2010).…”

mentioning

confidence: 99%

Self-Reported Sleep Problems in Adolescent Survivors of Childhood Cancer

Desaulniers¹,

Riley²,

Vangle³

et al. 2015

CJON

View full text Add to dashboard Cite

Sleep problems were reported before treatment (6%), during treatment (18%), after treatment (15%), and at present (11%). ASCC reporting sleep problems reported more adverse psychosocial outcomes than those without. Significant associations (p ≤ 0.05) between sleep problems and difficulty in school were identified at all time points. Sleep problems were associated with depressive symptoms, memory problems, and anxiety during and after treatment and at present.

show abstract

“…Pilot data suggested that the metabolic syndrome in childhood cancer survivors may be associated with alterations in the HPAA suggesting chronic stress (Yeap et al 2005). Survivors of childhood leukaemia treated without cranial irradiation have demonstrated increased morning cortisol levels with intact endocrine and cardiovascular responses to social stress in the short term (Gordijn et al 2012(Gordijn et al , 2013. However, a potential impact of adrenal insufficiency on neurocognitive outcomes has been reported in leukaemia survivors (Cheung et al 2017).…”

Section: Relationship Between Hpaa Function and Wider Aspects Of Healthmentioning

confidence: 99%

The hypothalamic–pituitary–adrenal axis in childhood cancer survivors

Wei¹,

Crowne²

2018

Endocrine-Related Cancer

View full text Add to dashboard Cite

Endocrine abnormalities are common among childhood cancer survivors. Abnormalities of the hypothalamic-pituitary-adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic-pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment.

show abstract

Hypothalamic-pituitary-adrenal axis function in survivors of childhood acute lymphoblastic leukemia and healthy controls

Cited by 24 publications

References 70 publications

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

Self-Reported Sleep Problems in Adolescent Survivors of Childhood Cancer

The hypothalamic–pituitary–adrenal axis in childhood cancer survivors

Contact Info

Product

Resources

About