Study: Adrenal Insufficiency Found in Some MM Patients on Corticosteroid-Based Chemotherapy

About half of patients with multiple myeloma (MM) who received corticosteroid therapy along with long-term chemotherapy had adrenal insufficiency (AI), according to a recent study published in BioMed Research International.

The results from the retrospective study also revealed that a majority of patients diagnosed with AI presented with suspicious symptoms and signs of AI while being tested with rapid adrenocorticotropic hormone (ACTH) stimulation, indicating that the clinical suspicion of AI is critical for its detection regardless of underlying corticosteroid therapeutic regimen.

“Our study is valuable as it determines the real world incidence and clinical risk factors of AI in patients with MM based on a large retrospective cohort. The present findings can alert clinicians to consider adrenal suppression following corticosteroid-based chemotherapy in patients with MM,” the investigators wrote.

Corticosteroid therapy is used to treat several types of cancer, including MM. AI is the most common adverse event associated with corticosteroid use. The majority of patients with MM are exposed to long-term and high dose corticosteroids during chemotherapy treatment and thus, are more prone to developing AI. However, some reports have disputed this claim.

If untreated, AI could be life-threatening, and corticosteroid replacement is key for preventing AI-related trauma, the need for surgery, and severe infection. Therefore, early diagnosis is AI and proper replacement of corticosteroids are important for reducing mortality risks among the MM population.

Between January 2005 and December 2018, the investigators collected data from patients newly diagnosed with MM who received chemotherapy and underwent a paid ACTH stimulation test during follow-up at the Chonnam National University Hwasun Hospital in the Republic of Korea. Medical records were used to obtain information on clinical characteristics and corticosteroid type, dose, and duration.

In total, 282 of 414 eligible patients were included in the analysis. The average (SD) age of the cohort was 66.6 (8.8) years and 52.5% (n = 148) were men. Overall, 142 patients were found to have AI and 140 patients did not have AI. About 75.0% of patients in the no-AI group received chemotherapy at the time of the rapid ACTG stimulation test compared with 80.3% of patients in the AI group.

The median cumulative dose of corticosteroids was significantly lower in the AI group compared with patients in the no-AI group (25,632 mg vs 28,834 mg; P = .013). Additionally, the AI group had a higher prevalence of megestrol acetate use compared with the no-AI group (33.1% vs 15.7%; P = .001).

After diagnosis of AI, corticosteroid therapy was replaced with between 10 mg and 20 mg of hydrocortisone or an equivalent use of another steroid. Adrenal crisis was also observed in 3 patients during the study observational period.

During the univariate analysis, cumulative duration of corticosteroid use and cumulative dose per duration of corticosteroid use did not differ between the 2 groups. Cumulative dose corticosteroids (OR, 0.99; 95% CI, 0.98-0.99; P = .020) and megestrol acetate use (OR, 2.63; 95% CI, 1.48-4.67; P = .001) were found to have significant associations with AI. During the multivariate analysis, only the association between AI and megestrol acetate use remained statistically significant (OR, 2.54; 95% CI, 1.41-4.60; P = .002).

Suspicious symptoms and signs of AI, such as general weakness, dizziness, hypotension, gastrointestinal problems, and anorexia, were detected in 95.8% of patients in the AI group compared with the no-AI group (87.1%; P = .009).

The study had several limitations including that an overestimation of AI prevalence may have occurred and a causal relationship between megestrol acetate and AI was difficult to determine. The investigators said interpretation of the results requires caution.

Reference

Yoon JH, Ahn S, Jung S, et al. Prevalence and risk factors for adrenal insufficiency in patients with multiple myeloma receiving long-term chemotherapy including corticosteroids: a retrospective cohort study. Biomed Res Int. Published online December 13, 2021. doi:10.1155/2021/2330417