ESPE Abstracts (2019) 92 P1-11

Assessment of the Adrenal Function in Children with Acute Lymphoblastic Leukemia Before and After Induction Therapy with Corticosteroids

Naji Walad Dhawi1, Doaa Khater2,3, Saif Al-Yaarubi2, Irfan Ullah Ullah2, Yasser Wali2,3


1Oman medical specialty board, muscat, Oman. 2Sultan Qaboos University Hospital, Muscat, Oman. 3Alexandria university children hospital, Alexandria, Egypt


Background: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Corticosteroids are the cornerstone in treatment of pediatric ALL. Steroids can cause several side effects including secondary adrenal insufficiency with disruption of cortisol response to stress causing morbidity and even mortality in those children.

Objective: To assess the adrenal gland function of children with ALL before and after induction therapy with corticosteroids and identify who required replacement till gland recovery.

Methods: Newly diagnosed ALL cases during the period from December 2016 till end of January 2018 were recruited from pediatric hematology/oncology ward at Sultan Qaboos University Hospital. Basal Adrenocorticotrophic hormone (ACTH) and cortisol levels were done at 7:30 am before and after induction therapy with Corticosteroids. ACTH stimulation test using a standard dose of (250 mcg) was done for those with low cortisol after induction and hydrocortisone replacement was started in cases with abnormal test response with follow up every 4 weeks to check their serum cortisol till recovery of adrenal gland.

Results: Thirty-two patients with ALL were recruited; 62.5 % of them were males. The mean age of the cases was 5.94 years ± 2.75. Nine patients (28.1%) was found to have low cortisol after induction phase who were given hydrocortisone replacement with follow up every 4 weeks till full recovery.There was a statistically significant difference in the mean basal cortisol level between pre-chemotherapy stage (mean ±SD= 377.94±177.09) and post-chemotherapy stage (mean ±SD= 167.03±131.31). The mean reduction in cortisol level was 210.91 (95% CI= 135.35 – 286.46) and P<0.01

Conclusion: Cortisol level assessment must be obtained after steroids discontinuation for all patients with ALL. Steroids replacement therapy should be started immediately if abnormal levels were detected and follow up is required.

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