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.