Endocrine Abstracts

Objective: The aim was to investigate awakening salivary cortisol response (ACR) and its subsequent rise in normal prepubertal children and prepubertal survivors of leukaemia.

Methods: 90 patients fulfilling the criteria of >1 year post treatment for leukaemia, >6 months off steroids, prepubertal, 5–12 years and in remission were recruited. Group1 Bone Marrow Transplantation (BMT) had Total Body Irradiation (n=26), Group2 Chemotherapy only (n=31) and Group3 Controls (n=33) were siblings or best friends. Ethical approval and informed consent was obtained. Salivary cortisols were collected for 3 days- awakening (T1), 30 minutes post awakening (T30). Samples were analysed using radioimmunoassays.

Results: Mean salivary cortisol(T1) in Group1 (n=17) was 4.78 ng/ml, Group2 (n=27) 5.43 ng/ml and Group3 (n=22) 5.12 ng/ml. (NS). The (T30) salivary cortisol was significantly different between groups (Anova P=0.036). Group1 was 3.88 ng/ml (n=14) vs Group3 7.59 ng/ml (n=20) (P=0.032). Group2 (n=26) 7.2 ng/ml vs Group3 (P=0.936) (Dunnets t test) Subsequent paired sample t- test in Group1 and 2 did not reveal any significant rise in (T30) salivary cortisols either in males and females. Group3 showed significant rise in salivary cortisol (P=0.003) mainly mediated by male P=0.006 but not in females. (P=0.178).

Conclusion: Healthy prepubertal boys but not girls show a normal ACR and 30 minute rise. Prepubertal survivors post BMT and Chemotherapy (neither boys or girls) demonstrated a significant rise in their 30 minute awakening salivary cortisol. Survivors of Leukaemia post BMT also have significantly decreased 30 minute mean salivary cortisol. Prepubertal survivors of Leukaemia may have subtle Hypothalamic pituitary adrenal axis dysfunction as a consequence of therapy which is more pronounced in the BMT group and requires further investigation.