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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.
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.
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