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[Is there a risk of steroid-induced adrenal deficit after induction treatment of acute lymphoblastic leukemia?].
- Source :
-
Archives de pediatrie : organe officiel de la Societe francaise de pediatrie [Arch Pediatr] 2010 Dec; Vol. 17 (12), pp. 1637-44. Date of Electronic Publication: 2010 Oct 12. - Publication Year :
- 2010
-
Abstract
- The occurrence of eight cases of adrenal deficit in children hospitalized for acute lymphoblastic leukemia (ALL) led us to conduct a prospective study from May 2006 to May 2007 to better characterize this corticoid-induced adrenal deficit. Forty of the 48 patients hospitalized for ALL were given a low-dose Synacthen test (1 μg), a mean 7 days after the induction phase. An adrenal deficit was diagnosed in 27 patients (67.5%). No significant clinical or hematological difference was identified between the "with deficit" (n = 27) and "without deficit" (n = 13) groups. The diagnosis of adrenal deficit was not more common for children who had received dexamethasone (13/19) or prednisone (14/21), or for those who had (19/29) or had not (8/11) experienced corticoid toxicity during induction. The clinical signs suggesting adrenal deficit were identical in the two groups and none of the children presented an acute episode. In biological terms, only hypoprotidemia was significantly more common in patients with adrenal deficit (p = 0.0004). Of 13 patients with a deficit at the end of the induction who had received a 2nd low-dose Synacthène(®) test before intensification no. 1, 3 weeks on average after the end of corticotherapy, only two still had a deficit. Thus, corticoid-induced adrenal deficit is a common complication in children treated for ALL, although it is not highly symptomatic. Most of these children recover normal adrenal function before intensification no. 1, but it does not eliminate the risk of a secondary deficit after other courses of corticotherapy. Systematic repeated Synacthène(®) tests in common practice among children treated for ALL does not seem justified. However, the results of this study encouraged us to propose a hydrocortisone substitution to children treated for ALL in the event of stress.<br /> (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Adolescent
Adrenal Insufficiency drug therapy
Child
Child, Preschool
Cosyntropin
Dexamethasone administration & dosage
Female
Glucocorticoids administration & dosage
Hormones
Humans
Infant
Inpatients
Male
Prednisone administration & dosage
Prospective Studies
Risk
Treatment Outcome
Adrenal Insufficiency chemically induced
Adrenal Insufficiency diagnosis
Dexamethasone adverse effects
Glucocorticoids adverse effects
Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy
Prednisone adverse effects
Subjects
Details
- Language :
- French
- ISSN :
- 1769-664X
- Volume :
- 17
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Archives de pediatrie : organe officiel de la Societe francaise de pediatrie
- Publication Type :
- Academic Journal
- Accession number :
- 20943354
- Full Text :
- https://doi.org/10.1016/j.arcped.2010.09.001