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Glucocorticoids and insulin resistance in children with acute lymphoblastic leukemia
Author(s) -
Chow Eric J.,
Pihoker Catherine,
Friedman Debra L.,
Lee Stephanie J.,
McCune Jeannine S.,
Wharton Claire,
Roth Christian L.,
Baker K. Scott
Publication year - 2013
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24364
Subject(s) - medicine , insulin resistance , prednisone , overweight , dexamethasone , insulin , percentile , glucocorticoid , homeostasis , chemotherapy , lymphoblastic leukemia , endocrinology , obesity , gastroenterology , leukemia , statistics , mathematics
Background Children treated for acute lymphoblastic leukemia (ALL) are more likely to become overweight. Prolonged exposure to high‐dose glucocorticoids may cause insulin resistance and facilitate development of this phenotype. Procedure Body mass indices (BMI) and insulin resistance (homeostatic model assessment [HOMA]‐IR) were prospectively measured among on‐ (n = 31) and off‐therapy participants (n = 29). On‐therapy participants were assessed prior to and while on glucocorticoids (5 days of prednisone 40 mg m −2 or dexamethasone 6 mg m −2 ) given as part of routine maintenance chemotherapy, with a subset (n = 10) receiving an intravenous glucose tolerance test (IVGTT) while on glucocorticoids. Results Baseline HOMA‐IR values among on‐ and off‐therapy participants were similar, but among on‐therapy participants, HOMA‐IR increased significantly with glucocorticoid exposure (median 3.39 vs. 1.26; P < 0.01) with 45.2% of participants having values >4.39 (upper 2.5th percentile among normal weight adolescents). Although baseline HOMA‐IR was significantly correlated with current BMI (r = 0.48, P < 0.01), change in HOMA‐IR following steroid exposure was not correlated with any demographic or treatment characteristic including current BMI. Among those with IVGTT data, HOMA estimates in general correlated with values derived from a minimal model analysis (r ∼ 0.7). Conclusions High‐dose glucocorticoids given as part of routine chemotherapy were associated with a significantly increased insulin resistant state. Given the amount and duration of glucocorticoids children with ALL experience, these physiologic changes could be an important contributor to the development of therapy‐related obesity. Pediatr Blood Cancer 2013; 60: 621–626. © 2012 Wiley Periodicals, Inc.