Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
J Clin Res Pediatr Endocrinol. 2022 Dec 1;14(4):393-401. doi: 10.4274/jcrpe.galenos.2022.2022-2-2. Epub 2022 May 31.
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 identify the best markers for this assessment.
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 following 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); and 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 synthetic ACTH.
The study revealed lower level of PRA (1.94±0.98 ng/mL/h vs 3.61±4.85 ng/mL/h, p=0.029) and higher FBG (4.6±0.38 mmol/L vs 4.41±0.39 mmol/L, p=0.018) in the ALL group compared to controls. UFC correlated with evening cortisol (p=0.015, r=0.26), midnight cortisol (p=0.002, r=0.33), and DHEA-S (p=0.004, r=0.32). UFC also correlated with systolic and diastolic blood pressure (p=0.033, r=0.23 and p=0.005, r=0.31, respectively). The ACTH test confirmed impaired adrenal function in 4/43 ALL survivors (9%). Two of the patients who needed permanent hydrocortisone replacement had low UFC, midnight cortisol and DHEA-S levels.
These results highlight the importance of reviewing adrenal gland functionality 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.
肿瘤治疗可能会影响肾上腺，在应激情况下，可能导致危及生命的肾上腺危象。本研究的目的是评估急性淋巴细胞白血病（ALL）患儿的肾上腺功能，并确定评估其功能的最佳标志物。
本研究纳入了 43 例 ALL 幸存者（平均年龄 8.5±3.6 岁）和 45 名年龄和性别匹配的健康对照者。所有 ALL 患者在完成肿瘤治疗后 5 年内接受了一次评估。所有参与者均采集空腹血样，以测量：空腹血糖（FBG）；皮质醇；醛固酮；血浆肾素活性（PRA）；硫酸脱氢表雄酮（DHEA-S）；促肾上腺皮质激素（ACTH）。此外，还评估了皮质醇的日间水平和 24 小时尿游离皮质醇（UFC）。所有 ALL 幸存者均接受了 1μg 合成 ACTH 测试。
研究结果显示，与对照组相比，ALL 组的 PRA 水平更低（1.94±0.98ng/mL/h 比 3.61±4.85ng/mL/h，p=0.029），FBG 水平更高（4.6±0.38mmol/L 比 4.41±0.39mmol/L，p=0.018）。UFC 与傍晚皮质醇（p=0.015，r=0.26）、午夜皮质醇（p=0.002，r=0.33）和 DHEA-S（p=0.004，r=0.32）相关。UFC 还与收缩压和舒张压相关（p=0.033，r=0.23 和 p=0.005，r=0.31）。ACTH 测试证实 43 例 ALL 幸存者中有 4 例（9%）存在肾上腺功能受损。需要永久性氢化可的松替代治疗的 2 例患者 UFC、午夜皮质醇和 DHEA-S 水平较低。
这些结果强调了在 ALL 幸存者化疗/放疗后评估肾上腺功能的重要性。DHEA-S 被证明是评估肿瘤治疗后肾上腺功能的良好标志物。治疗后肾上腺轴的紊乱可能与代谢并发症有关。
