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Hull B, Wędrychowicz A, Ossowska M, Furtak A, Badacz J, Skoczeń S, Starzyk JB. The Assessment of the Hypothalamic-Pituitary-Adrenal Axis After Oncological Treatment in Pediatric Patients with Acute Lymphoblastic Leukemia. J Clin Res Pediatr Endocrinol 2022; 14:393-401. [PMID: 35633644 PMCID: PMC9724047 DOI: 10.4274/jcrpe.galenos.2022.2022-2-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Oncologic treatment can affect the adrenal glands, which in stressful situations may lead to life threatening adrenal crisis. The aim of the study was to assess adrenal function in pediatric acute lymphoblastic leukemia (ALL) survivors and to identify the best markers for this assessment. METHODS Forty-three ALL survivors, mean age 8.5±3.6 years and 45 age and sex-matched healthy controls were recruited to the study. ALL patients were assessed once within five years following oncological treatment completion. Fasting blood samples were collected from all participants to measure: fasting blood glucose (FBG); cortisol; aldosterone; plasma renin activity (PRA); dehydroepiandrostendione-sulfate (DHEA-S); and adrenocorticotropic hormone (ACTH). Moreover, diurnal profile of cortisol levels and 24-hour urinary free cortisol (UFC) were assessed. ALL survivors underwent a test with 1 ug of synthetic ACTH. RESULTS The study revealed lower level of PRA (1.94±0.98 ng/mL/h vs 3.61±4.85 ng/mL/h, p=0.029) and higher FBG (4.6±0.38 mmol/L vs 4.41±0.39 mmol/L, p=0.018) in the ALL group compared to controls. UFC correlated with evening cortisol (p=0.015, r=0.26), midnight cortisol (p=0.002, r=0.33), and DHEA-S (p=0.004, r=0.32). UFC also correlated with systolic and diastolic blood pressure (p=0.033, r=0.23 and p=0.005, r=0.31, respectively). The ACTH test confirmed impaired adrenal function in 4/43 ALL survivors (9%). Two of the patients who needed permanent hydrocortisone replacement had low UFC, midnight cortisol and DHEA-S levels. CONCLUSION These results highlight the importance of reviewing adrenal gland functionality after chemo/radiotherapy in ALL survivors. DHEA-S proved to be a good marker to assess the adrenal glands after oncological therapy. Post-treatment disturbances of the adrenal axis could be associated with metabolic complications.
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Affiliation(s)
- Barbara Hull
- Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland,University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
| | - Anna Wędrychowicz
- Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland,University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland,* Address for Correspondence: Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland Phone: +48 12 333 90 39 E-mail:
| | - Magdalena Ossowska
- University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
| | - Aleksandra Furtak
- Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland,University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
| | - Joanna Badacz
- University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
| | - Szymon Skoczeń
- Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric Oncology and Hematology, Cracow, Poland
| | - Jerzy B. Starzyk
- Jagiellonian University, Medical College, Pediatric Institute, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland,University Children’s Hospital, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
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Ossowska M, Teske E, Beirens van Kuijk L, Zandvliet M, De Vos JP. Treatment of multicentric or cranial mediastinal high-grade T-cell lymphoma in dogs with a first-line CCNU-L(-chlorambucil)-CHOP protocol. VLAAMS DIERGEN TIJDS 2016. [DOI: 10.21825/vdt.v85i5.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This retrospective study determined disease free survival (DFS) and progression free survival (PFS) in chemo-naïve dogs with multicentric or cranial mediastinal high-grade T-cell lymphoma, treated with a first-line CCNU-L(-chlorambucil)-CHOP protocol. Of thirteen dogs with multicentric lymphoma, 92.3% achieved a complete remission (CR), and the median DFS and PFS was 317 and 256 days, respectively. Three dogs had cranial mediastinal lymphoma, and achieved a CR with a median DFS and PFS of 978 and 1007 days, respectively. The oneand two-year DFS/PFS probability estimate for dogs with multicentric lymphoma was 0.50/0.46 and 0.42/0.38, respectively, for dogs with cranial mediastinal lymphoma 0.67/0.67. Neutropenia and thrombocytopenia were reported in 52.9% and 50% of the dogs, respectively, while 56.3% experienced grade 1-4 nephrotoxicity, hypothesized to be lomustine-induced. It was concluded that, compared to historical data, the currently described first-line CCNU-L(-chlorambucil)- CHOP protocol could benefit the survival of dogs with multicentric or cranial mediastinal highgrade T-cell lymphoma.
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Dzierzega M, Ossowska M, Chmiel D, Wieczorek A, Balwierz W. The malposition of central venous catheters in children. Pol J Radiol 2014; 79:275-8. [PMID: 25177409 PMCID: PMC4148418 DOI: 10.12659/pjr.890408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/28/2014] [Indexed: 11/09/2022] Open
Abstract
Background Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. Material/Methods A total number of 309 CVCs were implanted at Children’s University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. Results CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. Conclusions In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them.
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Affiliation(s)
- Maria Dzierzega
- Department of Pediatric Emergency, Medicine Children's University Hospital, Polish-American Institute of Pediatrics Jagiellonian University Medical College, Cracow, Poland
| | - Magdalena Ossowska
- Department of Pediatric Oncology and Hematology, Children's University Hospital, Polish-American Institute of Pediatrics Jagiellonian University Medical College, Cracow, Poland
| | - Dariusz Chmiel
- Department of Pediatric Emergency, Medicine Children's University Hospital, Polish-American Institute of Pediatrics Jagiellonian University Medical College, Cracow, Poland
| | - Aleksandra Wieczorek
- Department of Pediatric Oncology and Hematology, Children's University Hospital, Polish-American Institute of Pediatrics Jagiellonian University Medical College, Cracow, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Children's University Hospital, Polish-American Institute of Pediatrics Jagiellonian University Medical College, Cracow, Poland
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