[Brain atrophy as an artifact in ACTH administration]

An 8-month-old infant was treated for infantile spasms with long acting corticotrophin 25 IU daily for 32 days. CT, done 2 weeks after the treatment was discontinued, suggested diffuse brain atrophy. Repeat CT one year later was only borderline abnormal. No shift in the skull circumference curve was noted. Comparison to the literature led to the conclusion that the reversible changes in CT were caused by ACTH. The nature of this phenomenon is discussed as well as the implications for CT-diagnosis. The question arises whether ACTH or corticosteroids might cause irreversible brain damage.