en POLSKI
eISSN: 2083-8441
ISSN: 2081-237X
Pediatric Endocrinology Diabetes and Metabolism
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
SCImago Journal & Country Rank
 
4/2022
vol. 28
 
Share:
Share:
more
 
 
abstract:
Original paper

Assessment of adrenal function in pediatric cancer survivors

Barbara Hull
1, 2
,
Anna Wędrychowicz
1, 2
,
Magdalena Ossowska
2
,
Aleksandra Furtak
1, 2
,
Szymon Skoczeń
3, 4
,
Jerzy B. Starzyk
1, 2

1.
Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, Krakow, Poland
2.
Department of Pediatric and Adolescent Endocrinology, University Children’s Hospital in Krakow, Poland
3.
Department of Pediatric Oncology and Hematology, Pediatric Institute, Jagiellonian University Medical College, Krakow, Poland
4.
Department of Pediatric Oncology and Hematology, University Children’s Hospital in Krakow, Poland
Pediatr Endocrinol Diabetes Metab 2022; 28 (4): 250–256
Online publish date: 2022/08/03
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
PlumX metrics:
Introduction
Oncological therapy can temporarily or permanently disrupt adrenal gland function. The aim of our study was to assess the function of adrenal glands in cancer survivors and to find the best diagnostic tools for it.

Material and methods
Sixty patients aged 1.2–14.9 years (mean 8.3 ±3.5) with diagnosed malignancies and 45 healthy children as controls were recruited to the study. Patients were assessed 0–8 years (mean 2.4 ±2.0 years) after the oncological therapy. In all patients fasting blood samples were collected to measure: glucose, sodium, potassium, cortisol, aldosterone, plasma renin activity (PRA), dehydroepiandrostenedione-sulphate (DHEA-S), adrenocorticotropic hormone (ACTH) and antibodies against the adrenal cortex (AAA). Moreover, 24-hour urinary free cortisol (UFC) was assessed. Test with synthetic ACTH was carried out with 250 µg in neuroblastoma and nephroblastoma patients and with 1 µg in other oncological patients.

Results
The levels of morning cortisol and sodium were significantly lower and blood glucose were higher in cancer survivors than in controls (p = 0.006, p = 0.043, p = 0.008). Basal laboratory tests confirmed adrenal insufficiency (AI) in 1 patient with neuroblastoma. Low-dose ACTH revealed AI in 3 patients with acute lymphoblastic leukemia. In the study group, UFC correlated with evening and midnight cortisol (p = 0.001, p = 0.006). In the control group UFC correlated with DHEA-S (r = 0.623, p = 0.0001). None of assessed parameters correlated with the time since the completion of oncological therapy.

Conclusions
The study confirmed possibility of developing asymptomatic AI in cancer survivors even several years after therapy. Instead of morning cortisol, classical diagnostic low-dose ACTH test seems to be an optimal tool for adrenal function’s assessment.

keywords:

cortisol, acute lymphoblastic leukemia (ALL), adrenal insufficiency (AI), neuroblastoma (NBL), adrenocorticotropic hormone (ACTH) test


Quick links
© 2023 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.