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Normal spontaneous cortisol secretion in children after autologous bone marrow transplantation
Per Frisk1, Jan Gustafsson, Johan Arvidson
1Department of Women's and Children's Health, Uppsala University Children's Hospital, University Hospital, Uppsala, Sweden. per.frisk@kbh.uu.se
Insights
Spontaneous cortisol secretion is maintained in children after bone marrow transplantation (BMT), even with total body irradiation (TBI) or cranial irradiation (CRT). Cortisol levels normalized post-BMT, regardless of irradiation type.
Area of Science:
- Pediatric Endocrinology
- Hematology-Oncology
- Transplantation Medicine
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric acute leukemia and lymphoma.
- Assessing endocrine function, particularly cortisol secretion, post-BMT is vital for long-term patient health.
- The impact of different irradiation regimens on adrenal function requires detailed investigation.
Purpose of the Study:
- To characterize spontaneous cortisol secretion patterns in children undergoing autologous BMT.
- To evaluate the influence of chemotherapy, total body irradiation (TBI), and cranial radiation (CRT) on cortisol levels.
- To determine if cortisol secretion is preserved following BMT.
Main Methods:
- Analysis of spontaneous cortisol secretion in 39 pediatric patients before and after autologous BMT.
- Stratification into three groups: chemotherapy only (Group 1), chemotherapy + TBI (Group 2), and chemotherapy + TBI + prior CRT (Group 3).
- Measurement of mean morning cortisol levels and statistical comparison between groups and time points.
Main Results:
- Pre-BMT, morning cortisol was significantly lower in the TBI group (Group 2) compared to chemotherapy-only (Group 1).
- Six months post-BMT, morning cortisol levels significantly increased in both TBI (Group 2) and TBI + CRT (Group 3) groups.
- No significant changes in cortisol levels were observed in the chemotherapy-only group (Group 1) post-BMT.
- Neither TBI nor prior CRT were found to be associated with long-term changes in morning cortisol levels.
Conclusions:
- Spontaneous cortisol secretion is generally maintained in children following autologous BMT.
- The type of irradiation, including TBI and CRT, does not appear to negatively impact long-term cortisol secretion.
- Adrenal function, as assessed by morning cortisol, remains intact after BMT in this pediatric cohort.
Aim:
To describe spontaneous cortisol secretion in children after autologous bone marrow transplantation (BMT) for acute leukaemia and lymphoma.
Methods:
Spontaneous cortisol secretion was analysed in 39 children before and after BMT. Thirteen patients were conditioned with chemotherapy only (group 1), and 26 patients also with total body irradiation (TBI). In the TBI group, 14 patients had received no additional irradiation (group 2), whereas 12 patients had received cranial irradiation (CRT) previously (group 3).
Results:
Before BMT, in comparison with group 1, mean morning cortisol was significantly lower in group 2 (252 vs 415 mmol/l, p = 0.004), but not in group 3 (vs 312 mmol/l, p = 0.12). There was no change in group 1 six months after BMT (to 379 nmol/l), whereas morning cortisol increased significantly in group 2 and group 3 (to 386 and 343 nmol/l, respectively; p < 0.05). The change in mean morning cortisol correlated negatively with pretransplant morning cortisol (r = -0.63, p < 0.001). Neither TBI nor CRT were associated with changes in morning cortisol.
Conclusion:
Spontaneous cortisol secretion is maintained after BMT irrespective of whether cranial or total body irradiation has been given or not.
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