Intermittent High-Dose Glucocorticoid Treatment Does Not Cause Adrenal Insufficiency in Patients with Diffuse Large B-Cell Lymphoma : A Prospective Study

Abstract

Glucocorticoid (GC) treatment suppresses the hypothalamicpituitary- adrenal axis and can cause GC-induced adrenal insufficiency. In this study, we investigated the incidence of GCinduced adrenal insufficiency in patients receiving intermittent short-term high-dose oral GC treatment for newly diagnosed diffuse large B-cell lymphoma. Cosyntropin stimulation test was used to assess adrenal function at study entry (baseline), at 2 months (before the 5th cycle), and 6 months frombaseline (3months after the last cycle). Ten patients were included (40% women). Mean age was 61 years. The mean (range) plasma morning cortisol was 407 (320 530) nmol/L at baseline, 373 (260 610) nmol/L at 2 months, and 372 (230 520) nmol/L at 6 months from baseline. All patients had normal response to cosyntropin stimulation at baseline as well as 2 and 6 months from baseline. Thus, none of the patients developed biochemically verified adrenal insufficiency. Therefore, short-term high-dose GC therapy, a commonly used adjuvant treatment in patients with malignant hematological diseases, does not seem to down-regulate the hypothalamic-pituitary-adrenal axis.