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HPA axis function during adjunctive high-dose dexamethasone use in chemotherapy: a prospective pilot study.

Elżbieta Turska¹, Krzysztof Lewandowski², Igor Symonowicz¹

¹Department of Oncology, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.

Frontiers in Endocrinology

|May 11, 2026

Summary

High-dose dexamethasone during chemotherapy did not significantly suppress morning cortisol or ACTH levels in breast cancer patients. Further research is needed to assess hypothalamic-pituitary-adrenal (HPA) axis function during intermittent glucocorticoid use.

Keywords:

HPA axis adrenal insufficiency breast cancer chemotherapy dexamethasone

Related Experiment Videos

Area of Science:

Oncology
Endocrinology
Pharmacology

Background:

Glucocorticoid therapy can cause adrenal insufficiency via various administration routes.
The effect of intermittent high-dose glucocorticoids during chemotherapy on the hypothalamic-pituitary-adrenal (HPA) axis is not fully understood.

Purpose of the Study:

To prospectively evaluate the impact of intermittent high-dose dexamethasone premedication on HPA axis function in breast cancer patients undergoing chemotherapy.

Main Methods:

A prospective pilot study involving 47 women with breast cancer receiving paclitaxel-based chemotherapy.
Measured morning serum cortisol and adrenocorticotropic hormone (ACTH) longitudinally before dexamethasone administration.
Analyzed trends using ANOVA and Spearman correlation.

Main Results:

Morning cortisol and ACTH concentrations showed a general downward trend during treatment.
No statistically significant changes in cortisol or ACTH concentrations were observed.
Intermittent high-dose dexamethasone did not demonstrate significant suppression of morning cortisol or ACTH.

Conclusions:

Single cortisol measurements have limitations in assessing adrenal function during chemotherapy.
A longitudinal approach is crucial for evaluating HPA axis function in oncology patients receiving intermittent glucocorticoids.
Further studies with dynamic testing are necessary to determine optimal HPA axis assessment methods.