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A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients

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Abstract

Purpose

Dexamethasone has a high therapeutic index when used to prevent chemotherapy-induced nausea and vomiting. However, the chronic use of glucocorticoids has been associated with suppression of the hypothalamic–pituitary–adrenal axis. Therefore, the authors designed this pilot study to assess the incidence of adrenal insufficiency after dexamethasone therapy as an antiemetic in cancer patients receiving chemotherapy.

Methods

The rapid adrenocorticotropic hormone (ACTH) stimulation test was performed in 103 cancer patients, who had been treated with high-dose dexamethasone as an antiemetic for more than 3 months. When response to the rapid ACTH stimulation test was abnormal, the patient received corticosteroid replacement by prednisolone 7.5 mg daily for 1–2 weeks and after prednisolone replacement, changes in symptoms associated with adrenal insufficiency were investigated using a visual analog scale.

Results

Forty-five of the 103 patients (43.7%) showed a suppressed adrenal response to the rapid ACTH stimulation test, and the incidence of adrenal suppression was found to be significantly affected by megestrol acetate use (P = 0.035). Thirty-three patients with a suppressed adrenal function achieved an improvement in quality of life after prednisolone replacement, as determined using a self-report questionnaire (22.9 ± 14.7 to 14.8 ± 11.0, P < 0.001).

Conclusions

We suggest that suppression of adrenal response is common after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.

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Acknowledgments

This work was supported by the research grant of the Chungbuk National University in 2010.

Conflict of interest

We declare that no conflict of interest exists for any of the authors.

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Authors

Corresponding author

Correspondence to Seung Taik Kim.

Additional information

Hye-Suk Han and Young Kwang Shim contributed equally as first authors to this work.

Appendix A

Appendix A

A self-report questionnaire composed of six most common symptoms associated with adrenal insufficiency

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Han, HS., Shim, Y.K., Kim, J.E. et al. A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients. Support Care Cancer 20, 1565–1572 (2012). https://doi.org/10.1007/s00520-011-1248-z

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  • DOI: https://doi.org/10.1007/s00520-011-1248-z

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