[Adverse effects in children treated with ACTH in infantile spasm]
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Adrenocorticotropic hormone (ACTH) treatment for infantile spasms can lead to frequent side effects like Cushing-like appearance, irritability, and hypokalemia. Osteoporosis and hypertension are more common than previously thought, requiring regular monitoring.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Pharmacology
Context:
- Infantile spasms are a severe form of epilepsy in infants.
- Adrenocorticotropic hormone (ACTH) is a common treatment for infantile spasms.
- Long-term side effects of ACTH treatment require further investigation.
Purpose:
- To evaluate the frequency and spectrum of side effects associated with ACTH treatment in children with infantile spasms.
- To highlight previously under-recognized side effects such as osteoporosis and hypertension.
Summary:
- A ten-year study of 13 children treated with ACTH for infantile spasms revealed significant side effects.
- Common adverse events included Cushing-like appearance (11/13), irritability (9/13), hypokalemia (7/13), metabolic alkalosis (6/13), hypertension (5/13), infections (5/13), and osteoporosis (5/13).
- Osteoporosis and hypertension were found to be more frequent than previously recognized.
Impact:
- Recommends routine monitoring for osteoporosis (thoracic spine X-rays) and hypertension (blood pressure measurement).
- Suggests regular monitoring of electrolytes (calcium, phosphate, potassium, sodium) and urine for calcium.
- Advises urine and kidney ultrasound screening for ureteronephrolithiasis (kidney stones).
Abstract:
During a period of ten years, 13 children were treated for infantile spasms with ACTH. Eleven of these developed Cushing-like appearance, 9 irritability, 7 hypokalaemia, 6 metabolic alkalosis, 5 hypertension, 5 infections and 5 osteoporosis. This investigation reveals that osteoporosis is a more frequent side effect than previously recognized and, similarly, that hypertension is also a common side effect. Routine x-ray control of the thoracic spine, regular measurement of blood pressure and control of urinary calcium and serum calcium, phosphate, sodium and potassium are therefore recommended. As cases of ureteronephrolithiasis have also been observed, examination of the urine for blood and ultrasound examination of the kidneys for formation of calculi should also be considered.