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Cardiac hypertrophy secondary to ACTH treatment in children
Insights
Adrenocorticotropic hormone (ACTH) treatment for infantile epilepsy can cause myocardial hypertrophy in children. Echocardiograms revealed cardiac changes that resolved after ACTH cessation, suggesting ACTH-induced cardiac effects.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Endocrinology
Background:
- Adrenocorticotropic hormone (ACTH) is used to treat childhood epilepsy, but can cause significant side effects.
- Common complications include Cushing syndrome, infections, and hypertension.
- The cardiac effects of ACTH in children with epilepsy are not well-documented.
Purpose of the Study:
- To assess the cardiac effects of ACTH treatment in children with infantile myoclonic seizures.
- To investigate the reversibility of ACTH-induced cardiac changes after treatment cessation.
Main Methods:
- Seven patients with infantile myoclonic seizures treated with ACTH were monitored.
- Serial echocardiographic investigations were performed to assess cardiac function and structure.
- Cardiac findings were compared before, during, and after ACTH therapy.
Main Results:
- All seven patients exhibited myocardial hypertrophy with increased left ventricular function during ACTH treatment.
- These echocardiographic abnormalities resolved within 5 months after discontinuing ACTH therapy.
- No other significant cardiac complications were reported.
Conclusions:
- ACTH treatment in children with epilepsy may induce reversible myocardial hypertrophy and altered left ventricular function.
- Potential mechanisms include edema, glycogen deposition, hyperinsulinism, hypertension, or increased inotropic stimulation.
- Serial echocardiographic monitoring is recommended for children undergoing ACTH therapy to detect potential cardiac side effects.
Abstract:
The usefulness of ACTH in the treatment of childhood epilepsy is assessed by improvement in the EEG and in the clinical condition. However, pronounced side effects, even serious ones, must be encountered. The most common complications are Cushing syndrome, infections, and arterial hypertension. We report on seven patients with infantile myoclonic seizures, who exhibited myocardial hypertrophy with increased left ventricular function during ACTH treatment. These changes were detected and followed by serial echocardiographic investigations. Within a period of 5 months after the termination of ACTH therapy the abnormal echocardiographic findings disappeared. We believe that the cardiac hypertrophy is ACTH-induced. Based on the various biological effects of ACTH different explanations are proposed: oedema or deposition of glycogen in the myocardial tissue, hyperinsulinism, arterial hypertension and increased inotropic stimulus. Because of our observations, we suggest careful monitoring of children treated with ACTH by performing serial echocardiographic investigations.