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The growth-hormone in long-term steroid-treated patients with chronic active hepatitis
Insights
Chronic active hepatitis (CAH) patients treated with prednisone or L.A.S.C. generally maintain normal hypothalamo-pituitary axis (HPA) function. Long-term use (over two years) may lead to HPA suppression and growth impairment in children.
Area of Science:
- Endocrinology
- Hepatology
- Pediatrics
Background:
- Chronic active hepatitis (CAH) management often involves corticosteroids.
- Potential side effects of long-term corticosteroid use include hypothalamo-pituitary axis (HPA) suppression.
- The impact of prednisone and long-activity synthetic corticotrophin (L.A.S.C.) on HPA in CAH patients requires investigation.
Purpose of the Study:
- To assess HPA function in CAH patients undergoing treatment with prednisone or L.A.S.C.
- To identify potential correlations between treatment duration and HPA suppression.
- To evaluate the effects on growth in pediatric patients receiving these treatments.
Main Methods:
- Insulin hypoglycemia test (IHT) used to assess growth hormone release.
- 36 CAH patients analyzed, categorized by treatment (prednisone, L.A.S.C., untreated) and age.
- Treatment duration and patient age were key variables.
Main Results:
- HPA suppression was rare, observed in only two patients with prolonged treatment (>2 years).
- 34 out of 36 patients exhibited normal HPA function.
- Two prepubertal children on long-term steroids experienced stunted growth, persisting post-treatment.
Conclusions:
- Short-term (under two years) prednisone or L.A.S.C. treatment appears safe for HPA function in CAH patients.
- Extended treatment durations carry a risk of HPA suppression and growth impairment, particularly in children.
- Careful monitoring is advised for pediatric CAH patients on long-term corticosteroid therapy.
Abstract:
To determine whether the hypothalamo-pituitary axis (HPA) became suppressed in patients with chronic active hepatitis (CAH) treated with prednisone or long-activity synthetic corticotrophin (L.A.S.C.) for at least 12 months 36 patients with CAH were assessed for growth hormone release following insulin hypoglycemia test (IHT). Sixteen out of the 36 patients were treated with steroids, 11 with L.A.S.C. and 9 were untreated. Sixteen patients were less than 12 years old of whom 8 were treated with prednisone and 5 with L.A.S.C. and 3 untreated. Suppression of HPA was observed only in two patients of whom one was treated with prednisolone for 24 months and the other one received L.A.S.C. for 23 months. Normal HPA was observed in all the other 34 patients. Two patients aged 6 and 8 years were treated with steroids for 3 and 6 years respectively and showed impairment of the growth in height and remained permanently stunted even when steroids had been discontinued. Our data suggest that both steroids and L.A.S.C. treatment does not impair HPA in patients with CAH when administered for less than two years.