TY - JOUR
T1 - Hypothalamic-pituitary-adrenal axis function in survivors of childhood acute lymphoblastic leukemia and healthy controls
AU - Gordijn, Maartje S.
AU - van Litsenburg, Raphaele R.
AU - Gemke, Reinoud J.B.J.
AU - Bierings, Marc B.
AU - Hoogerbrugge, Peter M.
AU - van de Ven, Peter M.
AU - Heijnen, Cobi J.
AU - Kaspers, Gertjan J.L.
N1 - Funding Information:
This study was financially supported by the Dutch Cancer Society.
PY - 2012/9
Y1 - 2012/9
N2 - Of all malignancies in children, acute lymphoblastic leukemia (ALL) is the most common type. Since survival significantly improves over time, treatment-related side effects become increasingly important. Glucocorticoids play an important role in the treatment of ALL, but they may suppress the hypothalamic-pituitary-adrenal (HPA) axis. The duration of HPA axis suppression is not yet well defined. The present study aimed at assessing the function of the HPA axis by determining the cortisol awakening response (CAR) and the dexamethasone (DEX) suppression test in children that were treated for childhood ALL, compared to a healthy age and sex matched reference group. In addition, questionnaires regarding sleep, fatigue, depression and quality of life were completed by the children and their parents. Fourty-three survivors who finished their treatment for childhood ALL 37 (interquartile range 22-75) months before and 57 healthy controls were included. No differences in CAR were observed between ALL survivors and the reference group, but survivors of ALL had higher morning cortisol levels and an increased cortisol suppression in response to oral dexamethasone. Higher cortisol levels in childhood ALL survivors were associated with more fatigue and poorer quality of life. We conclude that the experience of a stressful life event in the past may have caused a long-term dysregulation of the HPA axis in childhood ALL survivors, as reflected in an increased cortisol production and an enhanced negative feedback mechanism.
AB - Of all malignancies in children, acute lymphoblastic leukemia (ALL) is the most common type. Since survival significantly improves over time, treatment-related side effects become increasingly important. Glucocorticoids play an important role in the treatment of ALL, but they may suppress the hypothalamic-pituitary-adrenal (HPA) axis. The duration of HPA axis suppression is not yet well defined. The present study aimed at assessing the function of the HPA axis by determining the cortisol awakening response (CAR) and the dexamethasone (DEX) suppression test in children that were treated for childhood ALL, compared to a healthy age and sex matched reference group. In addition, questionnaires regarding sleep, fatigue, depression and quality of life were completed by the children and their parents. Fourty-three survivors who finished their treatment for childhood ALL 37 (interquartile range 22-75) months before and 57 healthy controls were included. No differences in CAR were observed between ALL survivors and the reference group, but survivors of ALL had higher morning cortisol levels and an increased cortisol suppression in response to oral dexamethasone. Higher cortisol levels in childhood ALL survivors were associated with more fatigue and poorer quality of life. We conclude that the experience of a stressful life event in the past may have caused a long-term dysregulation of the HPA axis in childhood ALL survivors, as reflected in an increased cortisol production and an enhanced negative feedback mechanism.
KW - Acute lymphoblastic leukemia
KW - Child
KW - Cortisol awakening response
KW - Dexamethasone suppression test
KW - HPA-axis
UR - http://www.scopus.com/inward/record.url?scp=84864781319&partnerID=8YFLogxK
U2 - 10.1016/j.psyneuen.2012.01.014
DO - 10.1016/j.psyneuen.2012.01.014
M3 - Article
C2 - 22385687
AN - SCOPUS:84864781319
SN - 0306-4530
VL - 37
SP - 1448
EP - 1456
JO - Psychoneuroendocrinology
JF - Psychoneuroendocrinology
IS - 9
ER -