The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

The effect of glucocorticoid therapy on adrenal reserve in patients with multiple myeloma. (#231)

Flavian Joseph 1 2 , Jane Tellam 1 2 , Sheila Cook 1
  1. Toowoomba Hospital, South Toowoomba, QLD, Australia
  2. Gold Coast University Hospital, Southport, QLD, Australia


The intermittent nature of high-dose glucocorticoid(GC) therapy in patients with multiple-myeloma could result in secondary adrenal-insufficiency (AI) and reduced quality of life.


We investigated the likelihood of secondary AI in patients with multiple-myeloma receiving intermittent GC therapy using the LDSST, measuring both serum and salivary cortisol levels.  We investigated differences in AddiQoL scores during periods with and without GC therapy.


Cross-sectional, prospective-cohort study.


This study was conducted from February 2017 to December 2017 at Toowoomba Hospital.


We included five patients with multiple-myeloma who received GC therapy as part of their chemotherapy protocol.


All 5 patients underwent a LDSST and salivary cortisol tests at the nadir of GC effect. AddiQoL surveys were completed pre- and post-GC therapy.

Main Outcome Measures

Primary outcome measure was the presence of biochemical AI and the correlation between results of the validated AddiQoL questionnaires in the period pre- and post-GC therapy. Our secondary outcome measure was assessing the utility of salivary cortisol in a LDSST.


One participant had more than 83% likelihood of secondary AI with a baseline serum cortisol level of 93nmol/L and 30minute serum cortisol of 389nmol/L after LDSST. Three participants had baseline serum cortisol levels 147nmol/L, 242nmol/L and 279nmol/L with elevations to 473nmol/L, 580nmol/L and 574nmol/L respectively after LDSST indicating 33% likelihood of AI. The remaining participant had a baseline serum cortisol of 380nmol/L increasing to 614nmol/L at 30minutes post LDSST indicating 5% likelihood of AI. Low pre-GC therapy AddiQoL scores is associated with low serum 30minute cortisol results. In all 5 patients, 30minute salivary cortisol incremented 3 to 8 times compared to baseline levels.



This pilot study demonstrates that current GC regimes used in patients with multiple-myeloma are likely to affect adrenal reserve. Repeat assessment in a larger sample size would be of value.