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Serum steroids and success of corticotropin therapy in infantile spasms
Insights
The ratio of dehydroepiandrosterone to androstenedione in serum can predict treatment success in infants receiving corticotropin therapy for infantile spasms, suggesting steroid factors beyond cortisol are involved.
Area of Science:
- Endocrinology
- Pediatric Neurology
- Biochemistry
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Corticotropin therapy is a standard treatment, but response varies.
- The exact mechanisms of corticotropin's efficacy are not fully understood.
Purpose of the Study:
- To investigate serum steroid profiles in infants with infantile spasms before and during corticotropin therapy.
- To identify potential steroid biomarkers predictive of therapeutic response.
Main Methods:
- Measured serum levels of 8 steroids and urinary cortisol excretion in 10 infants.
- Analyzed steroid concentrations before and during corticotropin treatment.
- Correlated steroid levels and ratios with clinical response to therapy.
Main Results:
- A high serum dehydroepiandrosterone-androstenedione concentration ratio significantly distinguished infants with a good therapeutic response from those with a poor response (p = 0.001).
- No significant distinction was found using individual serum steroid levels, 24-hour urinary cortisol, or the pregnenolone-progesterone ratio.
- These findings suggest that factors other than cortisol mediate the therapeutic effect of corticotropin.
Conclusions:
- The dehydroepiandrosterone-androstenedione ratio may serve as a predictive biomarker for corticotropin therapy in infantile spasms.
- The therapeutic action of corticotropin might involve steroidogenic pathways beyond cortisol production.
- Targeting the 3 beta-hydroxysteroid dehydrogenase system in the zona reticularis could be a potential therapeutic strategy.
Abstract:
Serum levels of 8 steroids and urinary cortisol excretion were determined in 10 infants before and during corticotropin therapy for infantile spasms. High serum dehydroepiandrosterone-androstenedione concentration ratio distinguished the 6 infants with good therapeutic response from the 4 with poor response (p = 0.001). No such distinction was obtained directly by any of the serum steroid levels, 24-hour urinary cortisol, or serum pregnenolone-progesterone concentration ratio. This suggests that the therapeutic effect of corticotropin may be mediated by steroid factors other than cortisol. Inhibition of the 3 beta-hydroxysteroid dehydrogenase system in zona reticularis might be beneficial during the corticotropin therapy.