Suppression of adrenal axis function after high-dose steroid therapy for childhood acute lymphoblastic leukemia in Iran

A 4 weeks course of high-dose glucocorticoids (GCs) may cause prolonged adrenal suppression even after a 9 days tapering phase. In this study, adrenal function and signs and symptoms of adrenal insufficiency were prospectively assessed in children with acute lymphoblastic leukemia (ALL) after induction treatment with high-dose prednisone. In 42 children with newly diagnosed ALL, a baseline serum cortisol level was assessed and after receiving a 28 days of high dose prednisone according to the Berlin-Frankfurt-Munster 2009 protocol ad a 9 days tapering phase, serum cortisol level was assessed again and those whose serum cortisol level was normal underwent low-dose adrenocorticotropic hormone (LDACTH) stimulation 24 h after the last tapered steroid dose. Signs and symptoms of adrenal insufficiency were recorded during the observation period. All patients except one who was excluded had normal basal cortisol values at diagnosis. Twenty-four hours after last GC dose, morning cortisol was reduced in 15 (36.5%) patients. LDACTH testing showed adrenal suppression in 17 (41.4%) patients. High-dose GC therapy in ALL children may cause adrenal suppression even after a tapering phase. Laboratory monitoring of cortisol levels and steroid coverage during stress episodes may be indicated.