Is there any relationship between imatinib mesylate medication and hypothalamic-pituitary-adrenal axis dysfunction?

Area of Science:

• Endocrinology
• Hematology
• Pharmacology

Background:

• Imatinib mesylate is a tyrosine kinase (TK) inhibitor used for chronic myelogenous leukemia (CML).
• TK plays a crucial role in the hypothalamo-pituitary-adrenal (HPA) axis regulation.
• Potential impact of TK inhibitors on HPA axis function requires investigation.

Purpose of the Study:

• To evaluate the integrity of the HPA axis in patients undergoing imatinib therapy for CML.
• To determine the prevalence of HPA axis dysfunction in this patient cohort.

Main Methods:

• Utilized Glucagon Stimulation Test (GST) to assess adrenal response.
• Employed a low-dose (1 microg) ACTH Stimulation Test (LDSST) for HPA axis evaluation.
• Assessed 25 patients diagnosed with CML and treated with imatinib.

Main Results:

• 68% of patients exhibited an impaired peak cortisol response (cut-off 500 nmol/L) during GST.
• 48% of patients failed the LDSST, indicating HPA axis deficiency.
• The majority of deficient patients presented with partial glucocorticoid deficiency.

Conclusions:

• Subclinical glucocorticoid deficiency is prevalent in CML patients treated with imatinib.
• Untreated HPA axis dysfunction can become life-threatening under stress (e.g., illness).
• Routine HPA axis monitoring may be warranted for CML patients on imatinib therapy.