Evaluation of the hypothalamic-pituitary-adrenal axis in children with leukemia before and after 6 weeks of high-dose glucocorticoid therapy.

Among the adverse effects arising from chronic high-dose glucocorticoid treatment, adrenal insufficiency secondary to suppression of the hypothalamic-pituitary-adrenal (HPA) axis is a cause for concern. Glucocorticoid-induced adrenal suppression is related to the duration of therapy, type of steroid used and dosage, and schedule of glucocorticoid administration. To evaluate the suppression and recovery time of the HPA axis in children with acute leukemia, we performed the ovine CRH (oCRH) stimulation test in 15 patients, who were given high doses of dexamethasone as part of their induction chemotherapy for 42 days. The oCRH tests were performed before, and 7 and 14 days after, discontinuation of the glucocorticoid. The ACTH levels were not significantly different among the 3 tests. The cortisol levels, however, were significantly (albeit mildly) lower, both basally and after oCRH, 1 and 2 weeks post treatment than before therapy. Six patients had cortisol values that remained suppressed 2 weeks after discontinuation of therapy. One of these patients had manifestations of mild adrenal insufficiency, 6-8 days after discontinuation of therapy, but required no glucocorticoid coverage. We conclude that up to 2 weeks after discontinuation of 6 weeks of high-dose dexamethasone administration, the HPA axis of patients with acute leukemia is mildly suppressed but infrequently associated with clinical manifestations of adrenal insufficiency. This may indicate that major stress, when concurrent with glucocorticoid treatment, may prevent clinically significant adrenal suppression.

[Thyroid carcinoma in children and adolescents - review of six cases] / Carcinoma de tireóide em crianças e adolescentes - revisão de seis casos.

OBJECTIVE: Childhood thyroid carcinoma is a rare entity whose management is controversial. The objective of the present study was to evaluate the characteristics of these patients in terms of diagnosis and evolution. PATIENT AND METHODS: The evolution of six patients with thyroid cancer, followed at a Pediatric Endocrinology Unit during the past 17 years, was retrospectively reviewed. RESULTS: Six female patients with age ranging from 4.5 to 12 years were studied. In all 6 cases, thyroid nodules were present on the initial evaluation. Ultrasonography and 131I scintigraphy showed solid and cold nodules in four patients. Histologic findings indicated four papillary and two follicular carcinomas. All patients were submitted to total thyroidectomy; four were subsequently submitted to radiodine therapy due to the presence metastases and/or residual thyroid tissue. CONCLUSION: Our findings support the notion that children and adolescents with thyroid carcinoma have a positive prognosis; no cases of death occurred after 17 years of follow-up. Our data are in agreement with the literature, which describes low mortality rates for these cases.