D.A. Dzhavadov1, 2, E.M. Frantsiyants1, Yu.Yu. Kozel1, V.A. Bandovkina1, N.D. Cheryarina1, V.V. Dmitrieva1, O.V. Kozyk1, S.N. Dimitriadi1, K.S. Aslanyan3
1National Medical Research Centre for Oncology, Rostov-on-Don
2Rostov State Medical University, Rostov-on-Don
3Regional Childrenʼs Clinical Hospital, Rostov-on-Don
Dzhavadov D.A. — children’s oncologist of the Department of Children’s Oncology No. 1, post-graduate stident
63, 14th Line St., 344037 Rostov-on-Don, Russian Federation, tel.: +7-900-130-07-28, e-mail: dda.onco@yandex.ru, ORCID ID:0000-0002-7334-3034
Abstract. The study objective was to evaluate the levels of adrenocorticotropic hormone (ACTH), cortisol, dehydroepiandrosterone sulfate (DHEA-S), and their ratios in pubertal children with Hodgkin lymphoma (HL) before and 14 days after the completion of all courses of chemotherapy (CT).
Material and methods. The study was conducted between 2023 and 2025 and included pubertal children (n = 40) of both sexes (50% (n = 20) boys and 50% (n = 20) girls) with HL. The median age was 13.65 years (range: 11–17 years). The control group comprised conditionally healthy children (n = 40), also aged 11–17 (median age 15.25 years), with an equal sex ratio. In the main group, blood samples were taken before CT and 14 days after its completion to assess the levels of ACTH, cortisol, and DHEA-S. Reference values were based on the average hormone levels of conditionally healthy children (n = 40) of pubertal age.
Results. In boys with HL (n = 20), baseline levels of ACTH, cortisol, DHEA-S, and the cortisol/DHEA-S ratio did not significantly differ from the control group (p > 0.05). After completion of CT, ACTH levels increased 2-fold compared to baseline (p = 0.0000) and 1.9-fold compared to controls (p = 0.0000). Cortisol levels remained within the normal range in 75% (n = 15) of boys, while 25% (n = 5) showed a significant decrease — 3.9-fold compared to controls (p = 0.0000) and 4.1-fold compared to baseline (p = 0.0000). DHEA-S levels decreased in all boys: 2.5-fold lower than both control values and baseline (p = 0.0000). In girls with HL (n = 20), baseline ACTH was reduced 3.1-fold compared to controls (p = 0.0000), while cortisol was 1.3-fold elevated (p = 0.0152). DHEA-S was within the normal range in 35% (n = 7) of girls, whereas in 65% (n = 13) it was reduced 4.2-fold (p = 0.0000). After CT, ACTH levels increased 6.7-fold from baseline (p = 0.0000) and 2.1-fold relative to controls (p = 0.0000). Cortisol was elevated 1.5-fold in 50% (n = 10) of girls (p = 0.0027), while in the remaining 50% (n = 10) it was decreased 6.7-fold compared to controls and 8.6-fold compared to baseline (p = 0.0000). DHEA-S levels were reduced 4-fold in 65% (n = 13) of the girls (p = 0.0000).
Conclusion. Before CT, adrenal hormone dysfunction was observed only in girls. However, CT, including glucocorticoids, led to hypothalamic-pituitary-adrenal system dysfunction in boys as well. Most patients exhibited signs of secondary adrenal insufficiency after treatment, suggesting reduced adrenal cortex sensitivity to trophic stimulation and depletion of functional reserve.
Key words: Hodgkin lymphoma, adolescents, hormones, adrenocorticotropic hormone, cortisol, dehydroepiandrosterone sulfate.