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Research Article
Adrenal function testing in pediatric cancer survivors
Article first published online: 27 JUL 2009
DOI: 10.1002/pbc.22208
Copyright © 2009 Wiley-Liss, Inc.
Additional Information
How to Cite
Patterson, B. C., Truxillo, L., Wasilewski-Masker, K., Mertens, A. C. and Meacham, L. R. (2009), Adrenal function testing in pediatric cancer survivors. Pediatric Blood & Cancer, 53: 1302–1307. doi: 10.1002/pbc.22208
Publication History
- Issue published online: 9 OCT 2009
- Article first published online: 27 JUL 2009
- Manuscript Accepted: 23 JUN 2009
- Manuscript Received: 10 MAR 2009
- Abstract
- Article
- References
- Cited By
Keywords:
- basal cortisol;
- central adrenal insufficiency;
- late effects;
- low-dose corticotropin test
Abstract
Background
Central adrenal insufficiency is observed after cranial radiation therapy for cancer. Screening at risk patients is recommended, but the best screening strategy is unknown.
Methods
A retrospective review of pediatric cancer survivors who underwent hypothalamic/pituitary/adrenal axis testing was conducted. Data included: cancer diagnosis, radiotherapy dose, other endocrinopathies, and adrenal function testing. Adrenal testing included sequential low-dose corticotropin test (LDCT) and standard-dose corticotropin test (SDCT). 8 a.m. serum cortisol levels were compared to LDCT results. LDCT results were compared by radiotheroapy dose and according to the presence of endocrine comorbidities.
Results
Seventy-eight subjects (56% male, mean age at diagnosis 6.5 years) underwent testing. 67.9% had been treated with radiotherapy to the hypothalamus/pituitary. Mean time to diagnosis of adrenal insufficiency was 6.8 years after cancer diagnosis. Adequate adrenal function was found in 65% of patients by LDCT and 89% by SDCT. Only 21% of patients had basal serum cortisols collected at 8 a.m. Agreement between 8 a.m. baseline cortisol and LDCT was fair. Agreement between random baseline cortisol and LDCT was poor. Prevalence of central adrenal insufficiency diagnosed by LDCT increased with radiotherapy dose (8% for 10–19.9 Gy; 83% for ≥40 Gy) and the number of endocrine comorbidities.
Conclusions
In pediatric cancer survivors, central adrenal insufficiency was common even in patients receiving <40 Gy to the hypothalamus/pituitary. We recommend use of LDCT, not 8 a.m. serum cortisol to screen patients who received >30 Gy of radiotherapy and those with other central endocrinopathies. Pediatr Blood Cancer 2009; 53:1302–1307. © 2009 Wiley-Liss, Inc.