265 General discussion 8 Table 3. Continued Domain Directions for future research and clinical practice Metabolic changes and hunger Outcome measurement - New quantitative biomarkers which identify leptin signaling deficits - Measurement of more appetite-regulating hormones before and after high dose dexamethasone - Further exploration of feeling of hunger, eating behavior and caloric intake through a dietary diary - Measurement of body composition using air-displacement plethysmography or DXA scan Identification of patients at risk - Longitudinal cohort including all known risk factors and incorporating expenditure as well as intake Intervention - Development of targeted (physical activity) interventions (Pre-)clinical studies - Activation of the MR upon dexamethasone treatment in neural cell lines or brain tissue - Gene transcription (based on MR activation) in the brain of glucocorticoid treated patients - Labelled hydrocortisone addition in animal models to study uptake in the brain under dexamethasone treatment - Effectivity of hydrocortisone in comparison with dexamethasone or prednisone in the treatment of ALL Abbreviations: ALL: acute lymphoblastic leukemia, DXA: dual energy X-ray absorptiometry, MR: mineralocorticoid receptor, PAT: psychosocial assessment tool, PROMIS: Patient-Reported Outcomes Measurement Information System
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