Rix Mariane, Birkebaek Niels Holtum, Rosthøj Steen, Clausen Niels
Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.
J Pediatr. 2005 Nov;147(5):645-50. doi: 10.1016/j.jpeds.2005.06.006.
To investigate how frequently adrenal function fails to recover after corticosteroid therapy in children with acute lymphoblastic leukemia and to explore the clinical impact of slow adrenal recovery without steroid substitution.
Low-dose (1 microg) adrenocorticotropic hormone tests were performed before and after steroid courses and during infectious episodes in 24 children. Test results were not available during the study.
All 13 patients tested before treatment had normal adrenal responses. Adrenal suppression was found in 8 (47%) of 17 patients 5 days after discontinuation of a 5-week induction course of prednisolone and in 1 (20%) of 5 patients 7 days after a 3-week intensification course of dexamethasone, both courses being tapered over 9 days, as well as in all 13 patients tested 2 days after a 1-week prednisolone course. Clinically significant manifestations of adrenal suppression were noted in 3 (12%) patients. Of 204 scheduled tests, 131 were performed.
High-dose glucocorticoid therapy may cause adrenal suppression lasting more than 1 week in children with acute lymphoblastic leukemia, even after tapering the dose. We suggest steroid replacement during stress episodes within 1 to 2 weeks after discontinuation and thereafter testing adrenal function selectively in accordance with symptoms.
探讨急性淋巴细胞白血病患儿接受糖皮质激素治疗后肾上腺功能未能恢复的频率，并探讨肾上腺恢复缓慢且未进行激素替代治疗的临床影响。
对24名儿童在激素疗程前后以及感染发作期间进行低剂量（1微克）促肾上腺皮质激素试验。研究期间无法获得试验结果。
所有13名治疗前接受测试的患者肾上腺反应正常。在泼尼松龙5周诱导疗程停药5天后，17名患者中有8名（47%）出现肾上腺抑制；在地塞米松3周强化疗程停药7天后，5名患者中有1名（20%）出现肾上腺抑制，两个疗程均在9天内逐渐减量，以及在泼尼松龙1周疗程后2天接受测试的所有13名患者中也出现肾上腺抑制。3名（12%）患者出现肾上腺抑制的临床显著表现。在计划的204次测试中，进行了131次。
高剂量糖皮质激素治疗可能导致急性淋巴细胞白血病患儿肾上腺抑制持续超过1周，即使在剂量逐渐减量后也是如此。我们建议在停药后1至2周内的应激发作期间进行激素替代治疗，此后根据症状选择性地检测肾上腺功能。
