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Suppressed pituitary ACTH response after ACTH treatment of infantile spasms

D L Ross

    Journal of Child Neurology
    |January 1, 1986
    PubMed

    Insights

    Adrenocorticotropic hormone (ACTH) treatment withdrawal in children can transiently suppress their natural ACTH response. Tapered withdrawal and stress coverage are recommended to ensure adequate hormonal function during this period.

    Area of Science:

    • Pediatric Endocrinology
    • Neuroendocrinology

    Background:

    • Exogenous adrenocorticotropic hormone (ACTH) treatment can suppress the natural ACTH response in adults.
    • Guidelines for safely withdrawing ACTH treatment in children are lacking.
    • Observed suppressed morning cortisol levels in children undergoing ACTH treatment prompted further investigation.

    Purpose of the Study:

    • To evaluate the adrenocorticotropic hormone (ACTH) response in children after a tapered withdrawal of exogenous ACTH treatment.
    • To establish safe protocols for discontinuing ACTH therapy in pediatric patients.

    Main Methods:

    • Insulin tolerance tests were conducted in five children within 48 hours of completing a tapered ACTH withdrawal.
    • Adrenocorticotropic hormone (ACTH) response was assessed using radioimmunoassays for cortisol and beta-endorphin.
    • One child with an initial suppressed response underwent repeat testing six weeks later.

    Main Results:

    • Adequate ACTH responses (cortisol and beta-endorphin) were observed in four out of five children post-withdrawal.
    • One child initially exhibited suppressed basal and hypoglycemia-induced beta-endorphin and cortisol levels.
    • This child demonstrated normal responses upon repeat testing six weeks later, suggesting transient suppression.
    • The beta-endorphin response in this child supported a central suppression mechanism, potentially linked to prior adrenal hemorrhage during sepsis.

    Conclusions:

    • Transient suppression of the natural adrenocorticotropic hormone (ACTH) release can occur in some children following exogenous ACTH treatment.
    • A tapered withdrawal approach for ACTH treatment in children is advisable.
    • Providing stress coverage during and after ACTH withdrawal is recommended to manage potential adrenal insufficiency.

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