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01-07-2012 | Original Article

A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients

Authors: Hye-Suk Han, Young Kwang Shim, Jeong Eun Kim, Hyun-Jung Jeon, Sung-nam Lim, Tae-Keun Oh, Ki Hyeong Lee, Seung Taik Kim

Published in: Supportive Care in Cancer | Issue 7/2012

Abstract

Purpose

Dexamethasone has a high therapeutic index when used to prevent chemotherapy-induced nausea and vomiting. However, the chronic use of glucocorticoids has been associated with suppression of the hypothalamic–pituitary–adrenal axis. Therefore, the authors designed this pilot study to assess the incidence of adrenal insufficiency after dexamethasone therapy as an antiemetic in cancer patients receiving chemotherapy.

Methods

The rapid adrenocorticotropic hormone (ACTH) stimulation test was performed in 103 cancer patients, who had been treated with high-dose dexamethasone as an antiemetic for more than 3 months. When response to the rapid ACTH stimulation test was abnormal, the patient received corticosteroid replacement by prednisolone 7.5 mg daily for 1–2 weeks and after prednisolone replacement, changes in symptoms associated with adrenal insufficiency were investigated using a visual analog scale.

Results

Forty-five of the 103 patients (43.7%) showed a suppressed adrenal response to the rapid ACTH stimulation test, and the incidence of adrenal suppression was found to be significantly affected by megestrol acetate use (P = 0.035). Thirty-three patients with a suppressed adrenal function achieved an improvement in quality of life after prednisolone replacement, as determined using a self-report questionnaire (22.9 ± 14.7 to 14.8 ± 11.0, P < 0.001).

Conclusions

We suggest that suppression of adrenal response is common after antiemetic dexamethasone therapy in cancer patients receiving chemotherapy.

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Title: A pilot study of adrenal suppression after dexamethasone therapy as an antiemetic in cancer patients
Authors: Hye-Suk Han
Young Kwang Shim
Jeong Eun Kim
Hyun-Jung Jeon
Sung-nam Lim
Tae-Keun Oh
Ki Hyeong Lee
Seung Taik Kim
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 7/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-011-1248-z

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