TY - JOUR
T1 - Adrenal function in adult long-term survivors of nephroblastoma and neuroblastoma
AU - van Waas, Marjolein
AU - Neggers, Sebastian J C M M
AU - van Eck, Judith P
AU - van Noesel, Max M
AU - van der Lely, Aart-Jan
AU - de Jong, Frank H
AU - Pieters, Rob
AU - van den Heuvel-Eibrink, Marry M
N1 - Copyright © 2012 Elsevier Ltd. All rights reserved.
PY - 2012/4
Y1 - 2012/4
N2 - BACKGROUND: Adrenal insufficiency, or relative insufficiency, might partly explain increased mortality rates in nephroblastoma and neuroblastoma survivors after unilateral adrenalectomy.OBJECTIVE: To assess adrenal function and its metabolic effects in survivors after adrenalectomy.METHODS: In this cross-sectional study, 67 adult long-term survivors of nephroblastoma, 36 survivors of neuroblastoma and 49 control subjects participated. Adrenal function was assessed by a 1μg short Synacthen-test. Levels of cortisol, adrenocorticotrophic hormone (ACTH), low (LDL-C) and high-density lipoprotein-cholesterol (HDL-C), triglycerides, apolipoprotein-B, glucose and insulin were assessed in blood samples taken at baseline. In addition, cortisol levels were assessed after 30 (t=30) and 60 min. Homoeostatic Model Assessment (HOMA) was calculated.RESULTS: Adrenal insufficiency was not present in survivors. Interestingly, baseline serum cortisol levels were higher in survivors after unilateral adrenalectomy (mean 503 nmol/l) (N=46) than in survivors with both adrenals intact (mean 393 nmol/l, P=0.002) (N=52), and than in controls (mean 399 nmol/l, P=0.013) (N=49). After correcting for age, sex and use of oral oestrogens, unilateral adrenalectomy was independently associated with elevated baseline cortisol and ACTH levels. Baseline cortisol levels were positively associated with triglycerides (P<0.001), LDL-C (P=0.004), apolipoprotein-B (P<0.001) and HOMA (P=0.008).CONCLUSIONS: No adrenal insufficiency was observed in survivors of nephroblastoma and neuroblastoma. Survivors treated with unilateral adrenalectomy had relatively high basal cortisol and ACTH levels, indicating a higher central setpoint of the hypothalamic-pituitary-adrenal axis. This higher setpoint was associated with lipid concentrations and insulin resistance and can therefore influence the cardiovascular risk profile in long-term survivors of nephroblastoma and neuroblastoma.
AB - BACKGROUND: Adrenal insufficiency, or relative insufficiency, might partly explain increased mortality rates in nephroblastoma and neuroblastoma survivors after unilateral adrenalectomy.OBJECTIVE: To assess adrenal function and its metabolic effects in survivors after adrenalectomy.METHODS: In this cross-sectional study, 67 adult long-term survivors of nephroblastoma, 36 survivors of neuroblastoma and 49 control subjects participated. Adrenal function was assessed by a 1μg short Synacthen-test. Levels of cortisol, adrenocorticotrophic hormone (ACTH), low (LDL-C) and high-density lipoprotein-cholesterol (HDL-C), triglycerides, apolipoprotein-B, glucose and insulin were assessed in blood samples taken at baseline. In addition, cortisol levels were assessed after 30 (t=30) and 60 min. Homoeostatic Model Assessment (HOMA) was calculated.RESULTS: Adrenal insufficiency was not present in survivors. Interestingly, baseline serum cortisol levels were higher in survivors after unilateral adrenalectomy (mean 503 nmol/l) (N=46) than in survivors with both adrenals intact (mean 393 nmol/l, P=0.002) (N=52), and than in controls (mean 399 nmol/l, P=0.013) (N=49). After correcting for age, sex and use of oral oestrogens, unilateral adrenalectomy was independently associated with elevated baseline cortisol and ACTH levels. Baseline cortisol levels were positively associated with triglycerides (P<0.001), LDL-C (P=0.004), apolipoprotein-B (P<0.001) and HOMA (P=0.008).CONCLUSIONS: No adrenal insufficiency was observed in survivors of nephroblastoma and neuroblastoma. Survivors treated with unilateral adrenalectomy had relatively high basal cortisol and ACTH levels, indicating a higher central setpoint of the hypothalamic-pituitary-adrenal axis. This higher setpoint was associated with lipid concentrations and insulin resistance and can therefore influence the cardiovascular risk profile in long-term survivors of nephroblastoma and neuroblastoma.
KW - Adolescent
KW - Adrenal Glands/physiopathology
KW - Adrenal Insufficiency/etiology
KW - Adrenalectomy
KW - Adrenocorticotropic Hormone/blood
KW - Adult
KW - Child
KW - Child, Preschool
KW - Cholesterol, LDL/blood
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Hydrocortisone/blood
KW - Infant
KW - Infant, Newborn
KW - Kidney Neoplasms/mortality
KW - Male
KW - Neuroblastoma/mortality
KW - Survivors
KW - Wilms Tumor/mortality
UR - http://www.scopus.com/inward/record.url?scp=84860457197&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2012.02.046
DO - 10.1016/j.ejca.2012.02.046
M3 - Article
C2 - 22513228
SN - 1879-0852
VL - 48
SP - 1159
EP - 1166
JO - European Journal of Cancer
JF - European Journal of Cancer
IS - 8
ER -