Abnormal cortisol levels in pediatric patients treated with glucocorticosteroids for acute lymphoblastic leukemia

Abstract

Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Although in the past ALL was incurable, today’s survival rate is as high as 80–90%. The most important drugs in its treatment are glucocorticosteroids (GCS). This study focuses on exogenous GCS — dexamethasone and prednisolone, which suppress the hypothalamic–pituitary–adrenal (HPA) axis. The main objective of this study was to analyze articles about steroid side effects in ALL therapy, factors contributing to the frequency of HPA axis suppression, and possible methods for its assessment. According to research, abnormal cortisol values have been observed in almost every patient treated for ALL. This means it is important to perform HPA axis stimulation tests. In the reviewed studies, adrenal crisis, hyperglycemia, obesity, iatrogenic Cushing’s disease, growth failure, increased risk of infection, and a high mortality rate have been reported to be the most important complications of this therapy. It is important to note that some authors classify patients in terms of cortisol level disorder predispositions. These include the age and sex of the patient, the type of glucocorticoid used in ALL therapy, and the duration of the therapy.