Department of Internal Medicine, Chungbuk National University College of Medicine, 410 Seongbong-ro, Heungduk-gu, Cheongju 361-711, South Korea.
Support Care Cancer. 2012 Jul;20(7):1565-72. doi: 10.1007/s00520-011-1248-z. Epub 2011 Aug 18.
Dexamethasone has a high therapeutic index when used to prevent chemotherapy-induced nausea and vomiting. However, the chronic use of glucocorticoids has been associated with suppression of the hypothalamic-pituitary-adrenal axis. Therefore, the authors designed this pilot study to assess the incidence of adrenal insufficiency after dexamethasone therapy as an antiemetic in cancer patients receiving chemotherapy.
The rapid adrenocorticotropic hormone (ACTH) stimulation test was performed in 103 cancer patients, who had been treated with high-dose dexamethasone as an antiemetic for more than 3 months. When response to the rapid ACTH stimulation test was abnormal, the patient received corticosteroid replacement by prednisolone 7.5 mg daily for 1-2 weeks and after prednisolone replacement, changes in symptoms associated with adrenal insufficiency were investigated using a visual analog scale.
Forty-five of the 103 patients (43.7%) showed a suppressed adrenal response to the rapid ACTH stimulation test, and the incidence of adrenal suppression was found to be significantly affected by megestrol acetate use (P = 0.035). Thirty-three patients with a suppressed adrenal function achieved an improvement in quality of life after prednisolone replacement, as determined using a self-report questionnaire (22.9 ± 14.7 to 14.8 ± 11.0, P < 0.001).
We suggest that suppression of adrenal response is common after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.
地塞米松在预防化疗引起的恶心和呕吐方面具有较高的治疗指数。然而，长期使用糖皮质激素与下丘脑-垂体-肾上腺轴抑制有关。因此，作者设计了这项初步研究，以评估接受化疗的癌症患者接受地塞米松作为止吐药治疗后肾上腺功能不全的发生率。
对 103 例接受高剂量地塞米松作为止吐药治疗超过 3 个月的癌症患者进行快速促肾上腺皮质激素（ACTH）刺激试验。当快速 ACTH 刺激试验的反应异常时，患者接受泼尼松龙 7.5mg 每日替代治疗 1-2 周，在泼尼松龙替代治疗后，使用视觉模拟量表调查与肾上腺功能不全相关的症状变化。
45 例（43.7%）患者对快速 ACTH 刺激试验的肾上腺反应受到抑制，并且发现肾上腺抑制的发生率受美司那醇醋酸酯的使用显著影响（P = 0.035）。33 例肾上腺功能低下的患者在接受泼尼松龙替代治疗后，生活质量得到改善，自我报告问卷评估结果为（22.9 ± 14.7 至 14.8 ± 11.0，P < 0.001）。
我们建议，接受化疗的癌症患者接受止吐地塞米松治疗后，肾上腺反应抑制较为常见。
