18 Chapter 1 treatment induced metabolic toxicity on three components of the metabolic syndrome as well as significant insulin resistance in 45-85% of all cases.58,59 This implies that the high dose glucocorticoid pulses which are frequently administered in ALL treatment trigger significant metabolic changes. In survivors of childhood ALL, obesity is a well-known late side effect, and glucocorticoid use is an independent risk factor for obesity in survivors.60 Leptin is an adipokine which is mainly produced by adipose tissue, and is among others involved in regulating food intake, which is also disturbed during glucocorticoid treatment.61 The effect of five days of dexamethasone on leptin, fat mass and feeling of hunger has not been studied before. By exploring these acute side effects of dexamethasone, new insights in the pathophysiological mechanisms of important late side effect may arise.
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