Rapid Adrenocortical Recovery After Short-term Glucocorticoid Therapy

Impaired adrenal function after glucocorticoid therapy in children with acute lymphoblastic leukemia

“…Lightner et al [13] studied 13 ALL patients after 1 month of prednisolone therapy (60 mg/m 2 /day). No ACTH stimulation test was performed, but all patients showed normal morning cortisol values 9 days after abrupt cessation of therapy.…”

“…The use of supplemental hydrocortisone for ALL patients has been discussed previously, but it does not seem to be routinely used [13][14][15]. Instead, patients have been carefully monitored in cases of clinical stress or unspecific symptoms, which could be ascribed to an adrenal insufficiency.…”

“…Some studies have found the recovery time to depend on the glucocorticoid dose and length of treatment [7][8][9] while others have not [10][11][12]. Previous studies in children with ALL have indicated that the adrenal function usually recovers within the first weeks after abrupt cessation of high-dose glucocorticoid therapy, but may occasionally remain suppressed up to 8 weeks [13][14][15]. For patients with ALL, prolonged adrenal insufficiency may be deleterious as chemotherapy-induced neutropenic infections are common [16].…”

Clinical Impact of Corticosteroid-Induced Adrenal Suppression during Treatment for Acute Lymphoblastic Leukemia in Children: A Prospective Observational Study Using the Low-Dose Adrenocorticotropin Test

“…Children with ALL have a significant treatment-related mortality rate as the result of infection, 6 and corticosteroid-induced adrenal insufficiency could be an important contributing factor. Some studies indicate that suppression is mild and short-lived [7][8][9] and others that it may be prolonged and clinically significant, requiring very slow tapering 10 or even substitution treatment for a period of time. 11 The discrepancies in the conclusions of these studies may depend on differences in the ALL glucocorticoid protocols, for example, dexamethasone 8-10 or prednisolone 7,8,10,12 and abrupt 7,8,10,12 or gradual 9,11 discontinuation of the glucocorticoid therapy.…”

“…Some studies indicate that suppression is mild and short-lived [7][8][9] and others that it may be prolonged and clinically significant, requiring very slow tapering 10 or even substitution treatment for a period of time. 11 The discrepancies in the conclusions of these studies may depend on differences in the ALL glucocorticoid protocols, for example, dexamethasone 8-10 or prednisolone 7,8,10,12 and abrupt 7,8,10,12 or gradual 9,11 discontinuation of the glucocorticoid therapy. Further, different tests for measuring adrenal function may influence the results: morning cortisol, 7 corticotropin-releasing hormone test (CRH test), 8,9 standard (250 mg) adrenocorticotropic hormone (ACTH) test, 10,11 or low-dose (1 mg) ACTH test.…”