Cortisol response in children with cancer and fever during chemotherapy - A prospective, observational study using random serum cortisol levels

Q: What was the main objective of the study?

To evaluate cortisol response during febrile episodes in pediatric oncologic patients receiving chemotherapy.

Q: How were cortisol and ACTH assessed in the study?

Random serum cortisol and ACTH were analyzed for each participant during febrile episodes, including at admission.

Q: What factors were linked to a low cortisol response (LCR)?

An LCR occurred frequently, with additional risk factors including dexamethasone exposure, prophylactic posaconazole, and a period of ≤7 days from the last glucocorticoid intake.

Aug 21, 2026

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Glucocorticoids are central to leukemia and lymphoma treatment, yet high doses can suppress the hypothalamic–pituitary–adrenal (HPA) axis and weaken stress responses during infections. This prospective observational study evaluates cortisol dynamics during febrile episodes in pediatric oncologic patients. Seventy-five patients with fever received random serum cortisol and ACTH testing; low cortisol response was defined as <14.6 μg/dL.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

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Introduction

Materials and Methods

Patients

DOI: 10. 1002/cam4 .5667 RESEAR CH ARTICLE Cortisol response in children with cancer and fever during chemotherapy: A prospective, observational study using random serum cortisol levels Ann Boekstegers | Heinrich Schmidt | Mathias Kurzay | Tanja Vallée | Eva Jung | Ilja Dubinski | Rebecca Maxwell | Irene Schmid Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany Correspondence Ann Boekstegers, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Lindwurmstraße 4, 80337 Munich, Germany. Email: ann.boekstegers@med.uni[muenchen.de](muenchen.de) Abstract Background: Glucocorticoids are crucial components of the treatment of leukemia and lymphoma. High doses can lead to suppression of the hypothalamic– pituitary–adrenal (HPA) axis and be causative for an impaired stress response during infection. This study aims to evaluate the cortisol response in pediatric oncologic patients during febrile episodes. Methods: Totally, 75 children and adolescents (5 months—18years) with fever during chemotherapy were consecutively enrolled in this study. In total, 47 patients received glucocorticoids as part of their treatment. Random serum cortisol and adrenocorticotropic hormone (ACTH) were analyzed in every patient. A low cortisol response (LCR) was defined as a cortisol level < 14.6 μg/dL. Results: In total, 52 (69%) patients had a cortisol level <14.6 μg/dL during fever. There was no significant difference between patients who received glucocorticoids and those who did not. Significantly lower cortisol levels were measured ≤7 days after last glucocorticoid intake compared to later time points. Nearly all patients treated with dexamethasone or prophylactic posaconazole demonstrated a LCR under stress (fever) . Conclusion: The incidence of an impaired HPA axis in pediatric cancer patients might be underestimated since 69% of the children in our study had a LCR during fever. Intake of dexamethasone, posaconazole and a time period of ≤7 days from the last glucocorticoid intake were additional risk factors for an LCR. However, we could not confirm that patients with a LCR fared worse than patients with a high cortisol response (HCR) . Therefore, a different cortisol threshold may be necessary for defining an impaired HPA axis in febrile oncologic patients without concomitant symptoms of AI. KEYWORDS adrenal insufficiency, chemotherapy, cortisol, glucocorticoids, pediatric oncology This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. 9248 | BOEKSTEGERS et al. 1 | INTRODUCTION The hypothalamic–pituitary–adrenal (HPA) axis plays an important role in the stress and immune response to infections. Cortisol has direct anti-inflammatory effects and inhibits cytokines enhancing the inflammatory cascade.1,2 HPA axis suppression and hence reduced adrenal cortisol production remains a cause of morbidity and mortality in children.3 Glucocorticoids are an important element in therapeutic regimens of childhood leukemia and lymphoma since they induce apoptosis in lymphoblastic cells.4 However, exogenous steroid therapy suppresses corticotropinreleasing hormone (CRH) and adrenocorticotropic hormone (ACTH) production and thus induces adrenal atrophy.5 Several studies have investigated the effects of glucocorticoids on the HPA axis in children with acute lymphoblastic leukemia (ALL) . The suppression persists for the first days after the abrupt withdrawal of glucocorticoid therapy. The duration of suppression shows great interpatient variability.6–14 Supportive therapy, such as opioids or azoles can also suppress the HPA axis.11,15,16 Stress in episodes of suppressed HPA axis can have severe conseque

FAQs

What was the main objective of the study?

To evaluate cortisol response during febrile episodes in pediatric oncologic patients receiving chemotherapy.

How were cortisol and ACTH assessed in the study?

Random serum cortisol and ACTH were analyzed for each participant during febrile episodes, including at admission.

What factors were linked to a low cortisol response (LCR)?

An LCR occurred frequently, with additional risk factors including dexamethasone exposure, prophylactic posaconazole, and a period of ≤7 days from the last glucocorticoid intake.

Aug 21, 2026

Upload by Skyler