Evaluation of hypothalamic-pituitary-adrenal axis suppression by low-dose (0.5 microg) and standard-dose (250 microg) adrenocorticotropic hormone (ACTH) tests in asthmatic children treated with inhaled corticosteroid

The aim of this study was to compare the results of low-dose (LDT) and standard-dose (SDT) ACTH tests in the assessment of adrenal function in 30 asthmatic children (mean age 9.35 +/- 1.9 years, 19 boys) who were treated with budesonide Turbohaler at conventional 400 microg or 600 microg daily doses for 8 weeks by a prospective, randomized, and open parallel study. Budesonide did not lead to any significant suppression of the hypothalamic-pituitary-adrenal (HPA) axis in either treatment group. However, when individual patient values were examined at the end point, peak cortisol concentrations after LDT were below 2 SDs of the pretreatment values in four patients (13.3%). Also, the increment in cortisol values was <200 nmol/l in all four patients. Decreased 24-hour urinary free cortisol excretion provided further evidence for HPA axis suppression in these patients. Two of these four poor responders to LDT showed normal stimulation with SDT. In conclusion, even with moderate doses and short-term use, adrenal suppression may occur in certain susceptible patients. The low-dose ACTH test is more reliable than SDT for the evaluation of such patients.     

Topical fluticasone propionate lotion does not cause HPA axis suppression

OBJECTIVE: To establish the absence of adrenal suppression of fluticasone propionate (FP) 0.05% lotion when applied extensively to children (3 months to 6 years), with moderate to severe atopic dermatitis (AD). STUDY DESIGN: Open-label, conducted at 6 US centers; 44 subjects (3 to 71 months) with widespread AD (mean body surface area treated, 65%) received FP lotion twice daily for up to 4 weeks. RESULTS: No significant differences in mean cortisol levels were detected before or after treatment. At baseline, mean (+/-standard deviation) cortisols before and after cosyntropin (CST) stimulation were 13 +/- 6 microg/dL and 35 +/- 6 microg/dL, respectively. End-treatment, pre-CST, and post-CST cortisols were 12 +/- 6 microg/dL and 33 +/- 8 microg/dL, respectively. All 42 subjects with end-treatment post-CST cortisols demonstrated a normal adrenal response to CST (>18.0 microg/dL). FP lotion was well tolerated. Subjects who had blood drawn for bioavailability showed no correlation between FP levels and end-treatment post-CST cortisols. CONCLUSIONS: In patients as young as 3 months, FP lotion had no effect on HPA axis function and did not cause skin thinning even when used extensively over widespread, severe inflammatory disease. These results, together with others from studies using cream and ointment, provide further evidence of the safety of FP.     

Corticotropin and cortisol response to maximal exercise testing in central diabetes insipidus

BACKGROUND: It is known that arginine vasopressin (AVP) has a stimulatory effect on corticotropin (adrenocorticotropic hormone; ACTH) and cortisol secretion especially during stress. The present study was designed to investigate the effect of stress on ACTH and cortisol levels in patients with central diabetes insipidus (DI) with endogenous AVP deficiency receiving AVP therapy, and to determine whether these children need steroid replacement during stress. METHODS: Seven patients with a median age of 12 years (range 7-13 years) with idiopathic central DI on appropriate Desmopressin (DDAVP) therapy (group 1) and seven healthy controls with a median age of 15 years (range 13-20 years; group 2) were included in the study. Acute stress was produced in all children by treadmill exercise, assessed by maximal oxygen consumption and heart rate. ACTH and cortisol levels were determined before and after exercise. RESULTS: In group 1, median ACTH level after exercise (28.3 pg/mL) was not different from the median value (24.0 pg/mL) before exercise. However, median cortisol level (10.5 microg/dL) was significantly increased (14.9 microg/dL; P < 0.05) with exercise. In group 2, cortisol (median 9.3 microg/dL) and ACTH levels (median 6.3 pg/mL) were significantly increased after exercise (15 mug/dL and 13.6 pg/mL, respectively; P < 0.05). There was no significant difference between the groups with respect to cortisol levels before and after exercise, but the stimulated ACTH levels after exercise were higher in patients with DI than in the controls (P < 0.05). A positive correlation was observed between total daily DDAVP dose and cortisol level after exercise (r(s)= 0.786, P < 0.05). CONCLUSIONS: Cortisol response during acute stress is normal in children with DI and these patients do not need extra steroid treatment during stress. In contrast, the normal cortisol response obtained by increased ACTH levels in these patients indicates an increased sensitivity of corticotroph cells.     

Correlation between plasma and salivary cortisol levels in preterm infants

We sought to determine correlations between plasma and salivary cortisol levels in preterm infants in the basal state and after adrenocorticotropic hormone (ACTH) stimulation during the first week of life. Infants (n = 48) were given ACTH or saline solution; each injection was separated by 24 hours. Salivary and plasma cortisol levels correlated at baseline (r = 0.67, P <.0001) and 1 hour after ACTH stimulation (r = 0.40, P =.0047). ACTH increased cortisol levels in plasma from 12.3 +/- 6.4 to 30.3 +/- 13.2 microg/dL (P <.0001) and in saliva from 1.0 +/- 0.8 to 2.6 +/- 1.0 microg/dL (P <.0001). The adrenal response to ACTH can be detected in the saliva of premature newborns during the first week of life.     

Hypoglycemia pathogenesis in children with dumping syndrome

Three children with severe hypoglycemic reactions secondary to dumping syndrome were studied to discern the mechanism by which hypoglycemia occurred. Symptoms in patient 1 developed after fundoplication, generalized autonomic dysfunction occurred in patient 2, and dumping syndrome developed in patient 3 after malplacement of a feeding gastrostomy tube. Average blood glucose levels studied during and after two to seven meals in each child were 375 +/- 97 mg/dL (mean +/- SD) 30 minutes postprandially and 35 +/- 10 mg/dL greater than 120 minutes later. Swings in glucose values were proportional to the volume of meals. Insulin and glucagon levels were followed during a single meal challenge test in each patient; the average glucose concentration increased to 356 +/- 59 mg/dL 30 minutes postprandially and decreased to 32 +/- 11 mg/dL at 150 +/- 30 minutes. Hormonal analyses indicated (1) inappropriate early release of glucagon (300 pg/mL at 15 minutes) in patient 1, (2) exuberant early release of insulin (maximum 190 +/- 15 microU/mL) resulting in rapid decrease in glucose concentration in all patients, (3) development and/or persistence of hypoglycemia after the decline in circulating insulin to undetectable levels, and (4) inadequate glucagon response to hypoglycemia resulting in sustained hypoglycemia. These data indicate that gross disturbances of the insulin-glucagon axis attend childhood dumping syndrome.     

Adrenal status in children with septic shock using low-dose stimulation test.

OBJECTIVES: There is paucity of data on the magnitude of absolute or relative adrenal insufficiency in septic shock, especially in children. We conducted a prospective study to determine the prevalence of adrenal insufficiency in children with septic shock using a low-dose Synacthen (1 microg) stimulation test. DESIGN: Cross-sectional study. SETTING: Pediatric intensive care unit in a tertiary care hospital in northern India. PATIENTS: Children with septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We performed cortisol estimation at baseline and after low-dose Synacthen (1 microg) stimulation at 30 and 60 mins in children with fluid refractory septic shock admitted to our pediatric intensive care unit. Basal cortisol levels <7 microg/dL and peak cortisol level <18 microg/dL were used to define adrenal insufficiency. An increment of <9 microg/dL after stimulation was used to diagnose relative adrenal insufficiency. As there is lack of consensus on the cutoffs for defining relative adrenal insufficiency using the low-dose adrenocorticotropic hormone test, we evaluated different cutoff values (increment at 30 mins, increment at 60 mins, greater of the two increments) and evaluated their association with the incidence of catecholamine refractory shock and outcomes. Children with sepsis but without septic shock were sampled for baseline cortisol levels as a comparison. Thirty children (15 girls) with septic shock were included; median age (95% confidence interval) was 36.5 (9.39- 58.45) months. Median Pediatric Risk of Mortality score was 22.5 (14.13-24.87). Fifteen (50%) children survived. The median (95% confidence interval) cortisol values at baseline and 30 mins and 60 mins after stimulation were 71 (48.74-120.23) microg/dL, 78.1 (56.9-138.15) microg/dL, and 91 (56.17-166.44) microg/dL, respectively. The median baseline cortisol value in age- and gender-matched children with sepsis was 11.5 microg/dL. None of the children with septic shock fulfilled the criteria for absolute adrenal insufficiency. However, nine (30%) patients had relative adrenal insufficiency (increment in cortisol <9 microg/dL). Of these nine patients, five (56%) died; of the 21 patients with a greater increment in cortisol after stimulation, ten died (p = .69). Compared with patients in septic shock with normal adrenal reserve, those with relative adrenal insufficiency had a higher incidence of catecholamine refractory shock (p = .019) but no difference in mortality rate (p = .69). On the sensitivity and specificity analysis using various cutoffs of increment, the best discrimination for catecholamine refractory shock was obtained with a peak increment <6 microg/dL. CONCLUSIONS: Relative adrenal insufficiency is common in children with septic shock and is associated with catecholamine refractory shock.     

Timing of peak serum cortisol values in preterm infants in low-dose and the standard ACTH tests

The low-dose ACTH test seems to reveal mild cases of adrenal insufficiency and is beginning to be preferred over the standard ACTH test in the evaluation of adrenal suppression both in infants and in adults. The concentration-time profile of plasma cortisol in infants after a low ACTH dose is obscure. In this crossover study, we compared timing of the peak values in the low-dose and the standard ACTH stimulation tests in preterm and full-term infants. We performed the standard ACTH tests (250 microg/1.73 m2) and the low-dose ACTH tests (1 microg/1.73 m2) on 10 infants (26-40 wk gestational age) and measured serum cortisol concentration at 0, 30, 40, 60, and 120 min by RIA. Nine of the infants had received postnatal glucocorticoid treatment, and most of them had also been treated with dexamethasone antenatally. In the low-dose test, the peak values occurred at 30 or 40 min in 9/10 patients. In the standard-dose test, the peak values occurred at 60 or 120 min in 8/10 patients. These results are comparable with those from adults. According to this study, blood samples for the low-dose ACTH test in infants should be taken before dosing and between 30 and 40 min after dosing.     

Adrenal and thyroid axis function in preterm ventilated baboons

Cortisol and thyroid hormones are critical to normal fetal development and neonatal transition, and baseline values and stimulation tests are abnormal after preterm birth. To evaluate cortisol and thyroxine (T4) responses that are not influenced by uncontrolled antenatal events associated with human preterm labor, we measured cortisol and T4 after standard-dose adrenocorticotropin (ACTH) and corticotropin-releasing hormone (CRH) stimulation tests, as well as high-dose CRH and thyrotropin-releasing hormone stimulation tests in baboons that were delivered for 3 separate protocols at 125 days of gestation (term is 186 days). The animals were surfactant treated and ventilated for up to 14 days. Some fetuses were exposed to fetal or maternal betamethasone, and some newborns were treated with 10 microg/kg T4 for 9 days after birth. Baseline cortisol levels were in a stress range of 30-60 microg/dl by day 5. Cortisol did not increase consistently until day 11 in response to a high CRH dose or ACTH. T4 treatment for 9 days after birth suppressed the cortisol responses and subsequent baseline T4 levels. The hypothalamic-pituitary-adrenal (HPA) axis was unresponsive to standard dose stimulation tests until 11 days of age in preterm baboons, indicating HPA immaturity.     

Influence of Long Term Inhalation of Beclomethasone Dipropionate on Pituitary Adrenal Axis Function in Asthmatic Children

目的　通过检测相关激素水平 ,探讨哮喘患儿吸入二丙酸倍氯米松后对垂体 肾上腺轴功能的影响。方法　将研究对象分成 4组 :正常对照组、哮喘组、短期吸入二丙酸倍氯米松组和长期吸入二丙酸倍氯米松组。应用放射免疫法 ,测定上述 4组儿童的促肾上腺皮质激素 (ACTH)和皮质醇 (cortisol)水平 ,以评估垂体 肾上腺轴功能状态及吸入二丙酸倍氯米松后对其的影响。结果　 4组儿童的血清ACTH和cortisol水平之间无明显差别 ;ACTH兴奋实验短期吸入治疗组和长期吸入治疗组与正常对照组和哮喘组比较皮质醇基础值无明显降低 ,与哮喘组比较反应值 (刺激值 -基础值 )则明显降低 (P <0 .0 5 )。结论　吸入治疗一定时间后可使肾上腺皮质功能达到轻度抑制状态 ,但并不随吸入时间延长而产生累积抑制效应。     

Adrenocortical response to adrenocorticotropic hormone in relation to duration of topical therapy and percutaneous absorption of hydrocortisone in children with dermatitis

To evaluate the effect of topical hydrocortisone therapy on cortisol secretion, the plasma cortisol response to a 2h adrenocorticotropic hormone (ACTH) test was determined in 17 children with dermatitis. Percutaneous absorption of hydrocortisone was measured in the acute phase of dermatitis by a 4h absorption test. Two-hour plasma cortisol in the ACTH test correlated inversely with the increment of plasma cortisol in the absorption test. The duration of topical hydrocortisone therapy had no significant influence on the adrenocortical response to ACTH. A moderately or severely subnormal 2h plasma cortisol level was observed in three infants after 3–5 months' topical therapy with hydrocortisone.Abbreviations ACTH adrenocorticotropic hormone - HPA hypothalmic-pituitary-adrenocortical     

Low-dose adrenocorticotropic hormone stimulation testing in term infants

BACKGROUND: Low-dose adrenocorticotropic hormone (ACTH) stimulation testing is a commonly accepted way to evaluate adrenal function in children. However, there are no published data on the use of this test in term infants less than 12 months of age outside the newborn period. METHODS: We identified 14 infants at our center who were full term and had one or more ACTH tests at less than 12 months of age to evaluate for secondary adrenal insufficiency (AI). We retrospectively assessed peak cortisol response in these infants to determine whether a cut-off of 20 microg/dl is appropriate to distinguish normal from abnormal adrenal function in this age group. RESULTS: Five infants had peak cortisol > or =20 microg/dl on their first ACTH test and had a clinical picture consistent with normal adrenal function. Nine infants had peak cortisol <20 microg/dl on their first ACTH test. When retested later in infancy, four of these patients achieved peak cortisol > or =20 microg/dl. CONCLUSIONS: In term infants, the low-dose ACTH stimulation test is useful for demonstrating normal adrenal function but is of limited value in diagnosing secondary AI. For infants with peak cortisol <20 microg/dl, clinical observation and repeat ACTH testing later in infancy clarified diagnosis.     

Hypothalamic-pituitary-adrenal axis function in very low birth weight infants treated with dexamethasone

The effect of dexamethasone therapy on hypothalamic-pituitary-adrenal axis function was prospectively investigated in very low birth weight infants with bronchopulmonary dysplasia. Ten infants (mean +/- SD birth weight 825 +/- 265 g, gestation 25.8 +/- 1.9 weeks, postnatal age 33.1 +/- 17.7 days) initially received intravenous dexamethasone, 0.5 mg/kg per day for 3 days, and then were weaned over a period of 45 +/- 19.0 days to a replacement dose, followed by a metyrapone test. Morning plasma cortisol and 11-deoxycortisol levels were measured before and after an oral metyrapone dose given at midnight. Five infants (group A: birth weight 876 +/- 313 g, gestation 26.2 +/- 1.3 weeks, age of entry 31.8 +/- 22.8 days) had normal metyrapone test results, and five infants (group B: 778 +/- 234 g, 25.4 +/- 2.5 weeks, 34.4 +/- 13.4 days) had suppressed test results. Group A infants, in comparison with group B infants, had higher basal cortisol plasma levels (14.52 +/- 12.53 and 3.00 +/- 1.38 micrograms/dL, P = .047), higher postmetyrapone 11-deoxycortisol plasma levels (3.11 +/- 3.93 and 0.55 +/- 0.51 micrograms/dL, P = .028), larger differences between basal and postmetyrapone cortisol levels (7.10 +/- 4.67 and 2.12 +/- 1.31 micrograms/dL, P = .047), and larger differences between basal and postmetyrapone 11-deoxycortisol levels (2.99 +/- 3.93 and 0.29 +/- 0.25 micrograms/dL, P = .009). The hypothalamic-pituitary-adrenal axis function in group B infants eventually returned to normal when they continued to receive low-dose dexamethasone therapy after a period of 36.8 +/- 16.6 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of cerebral hypothermia on cortisol and adrenocorticotropic hormone responses after umbilical cord occlusion in preterm fetal sheep

The hypothalamic-pituitary-adrenal (HPA) axis is essential for adaptation to stress. In the present study, we examined the hypothesis that head cooling with mild systemic hypothermia would adversely affect fetal adrenocorticotropic hormone (ACTH) and cortisol responses to an asphyxial insult. Chronically instrumented preterm fetal sheep (104 d of gestation, term is 147 d) were allocated to sham occlusion (n = 7), 25 min of complete umbilical cord occlusion (n = 7), or occlusion and head cooling with mild systemic hypothermia (n = 7, mean +/- SEM esophageal temperature 37.6 +/- 0.3 degrees C vs 39.0 +/- 0.2 degrees C; p < 0.05) from 90 min to 70 h after occlusion, followed by spontaneous rewarming. During umbilical cord occlusion, there was a rapid rise in ACTH and cortisol levels, with further increases after release of cord occlusion. ACTH levels returned to sham control values after 10 h in both occlusion groups. In contrast, plasma cortisol levels remained elevated after 48 h in both occlusion groups and were still significantly elevated in the hypothermia-occlusion group 2 h after rewarming, at 72 h, compared with the normothermia-occlusion and sham groups. In conclusion, hypothermia does not affect the overall HPA responses to severe asphyxia in the preterm fetus but does prolong the cortisol response.     

The hypothalamic-pituitary-adrenal axis in preterm infants weighing ≤ 1250 g: association with perinatal data and chronic lung disease

The hypothalamic-pituitary-adrenal axis (HPA) was examined in 34 ventilated preterm infants weighing ≤ 1250 g during the first week of life to evaluate the association between adrenal suppression and subsequent chronic lung disease. The second aim of the study was to detect perinatal and clinical differences between the infants with and without persistent suppression of the HPA after completion of dexamethasone treatment for chronic lung disease. To evaluate the HPA, the corticotropin-releasing hormone stimulation test was performed, and the cortisol and adrenocorticotropic hormone (ACTH) levels were measured by radioimmunoassay. No association could be found between the synthesis of cortisol and ACTH at the end of the first week of life and the development of chronic lung disease. After treatment with dexamethasone, baseline cortisol levels < 138 nmol l^-1 were found in 12 infants (46.2%), 8 of whom (30.8%) had cortisol values below 83 nmol l^-1. The perinatal data of these patients did not differ from infants without HPA suppression. However, the infants with cortisol levels < 83 nmol l^-1 after dexamethasone showed a significantly shorter need for mechanical ventilation and supplemental oxygen ( p < 0:01) and a lower incidence of chronic lung disease ( p < 0:05).     

Relationships between adrenocorticotropic hormone and cortisol are altered during clustered nursing care in preterm infants born at extremely low gestational age

BACKGROUND: Little is known about the effects of clustered nursing care on hypothalamic pituitary axis (HPA) responses in preterm infants in the neonatal intensive care unit. AIMS: To examine facial responses, adrenocorticotropic hormone (ACTH) and cortisol levels, and the relationship between ACTH and cortisol in preterm infants in two gestational age groups (extremely low gestational age [ELGA: < or =28 weeks]; very low gestational age [VLGA: 29-31 weeks]) under basal conditions and in response to routine nursing procedures. STUDY DESIGN: Within subjects' cross-over design in random order. SUBJECTS: Ninety preterm infants with no postnatal steroid exposure were studied at 32+/-1 weeks postconceptional age. OUTCOME MEASURES: Facial actions, ACTH and cortisol levels were measured after a 30 minute rest period and in response to routine clustered nursing care (CC). Changes in facial actions were analyzed using repeated measures ANOVA. MANOVA or Mann-Whitney U tests were used to determine differences in ACTH and cortisol between gestational age groups. Spearman rank correlations were used to examine relationships between perinatal variables and facial, ACTH and cortisol levels. RESULTS: All infants had significantly increased facial responses to CC (p=0.001). Infants having experienced higher numbers of skin breaking procedures 24 h before basal assessment had higher basal cortisol levels (r=0.30, p=0.01). In response to CC, ELGA infants showed no correlation between ACTH and cortisol levels; VLGA infants showed a strong, positive correlation (r=0.62, p=0.02). CONCLUSION: The pattern of relationship between ACTH and cortisol differs depending on gestational age at birth in response to clustered nursing care. Prior pain alters responsiveness and HPA dysregulation is apparent in ELGA infants.     

小剂量快速法ACTH1~39兴奋试验评价肾病综合征患儿肾上腺皮质功能初探

目的 尝试以国产ACTH1～39 小剂量快速法ACTH 兴奋试验评价肾病综合征患儿肾上腺皮质功能。方法 以18例泼尼松治疗不同阶段的肾病综合征患儿为研究对象，同一患儿于泼尼松治疗第1和第3天先后进行小剂量快速法ACTH兴奋试验（静脉注射ACTH1～391 U）和2 h法兴奋试验（ACTH1～3925 U溶于100 mL葡萄糖溶液中静脉滴注2 h），两次试验结果进行自身对照分析。结果 首次泼尼松治疗前、泼尼松足量分次服用和减量但仍每日均服用的10 例患儿两种试验方法自身对照的结果完全一致，隔日顿服泼尼松的8 例患儿中也有5 例结果完全一致，仅3 例泼尼松隔日顿服，用量在1 mg·kg-1患儿两种试验方法的结果不一致，小剂量快速法的结果为肾上腺皮质功能低下，而2 h法的结果为肾上腺功能正常。对两种试验结果进行Kappa 分析显示两者一致性好。结论 ACTH1～39 可以代替ACTH1～24进行小剂量快速法ACTH兴奋试验；小剂量快速法与2 h法ACTH1～39 兴奋试验的结果一致性好，且简单易行，能够在门诊完成，可以考虑用来替代2 h法ACTH1～39 评价肾病综合征患儿的肾上腺皮质功能。     

A 3-year-old girl with Graves' disease with hypoglycemia following transient adrenal hyporesponsiveness

A 3-year-old girl with Graves' disease developed a generalized convulsion as a result of hypoglycemia (25 mg/dL). At the time of the hypoglycemic seizure, her plasma adrenocorticotropin (ACTH) level (1460 pg/mL) was extremely high, but her serum cortisol level (28.4 microg/dL) was relatively low given the severe stress. The cortisol-releasing hormone (CRH) provocation test done after thyroid function had improved revealed normal ACTH and cortisol responses. Since there was no other cause of hypoglycemia, such as hyperinsulinemia, long-term starvation, suddenly advanced emaciation, or prolonged fasting, it was suspected that the transient adrenal hyporesponsiveness was the main cause of hypoglycemia.     

泼尼松治疗婴儿痉挛症有效性及HPA轴机制分析

目的 通过研究泼尼松治疗前后婴儿痉挛症(infantile spasm,IS)的发作、脑电图的改变及下丘脑-垂体-肾上腺(hypothalamus-pituitary-adrenal,HPA)轴功能的改变,探讨泼尼松治疗婴儿痉挛症的有效性、HPA轴在IS发病机制中的作用,阐明泼尼松控制痉挛发作的HPA轴相关机制.方法 共收集30例符合标准IS病例(IS组),与30例健康婴幼儿(对照组)对比,对30例IS病例在泼尼松治疗前后进行发作次数记录、EEG监测、HPA轴功能检测,采用化学发光法检测血清皮质醇、促肾上腺皮质激素(adreno-cortico-tropic-hormone,ACTH)水平;利用酶联免疫吸附法检测血清促肾上腺皮质激素释放激素(corticotro-phin Releasing hormone,CRH)水平.结果 用药前IS组血清CRH水平均较正常对照组高,且差异有统计学意义(P<0.05),而IS组血皮质醇、ACTH与正常对照组比较无明显差别,差异无统计学意义(P>0.05);平均每日发作串数、平均每日发作总次数分别与CRH呈正相关(P<0.05);应用泼尼松后,经泼尼松治疗后30例IS病例有19例发作控制,11例发作未控制,有18例脑电高度失律完全缓解,12例脑电高度失律未完全缓解,治疗后每日发作串数及每日发作总次数均较治疗前明显下降,差异有统计学意义(P<0.05),治疗后的DQ较治疗前DQ改善,有统计学意义(P<0.05),病程是泼尼松治疗效果的主要影响因素,病程越长,治疗效果越差,差异有统计学意义(P<0.05).治疗后的CRH、皮质醇、ACTH较治疗前明显下降,差异有统计学意义(P<0.05).结论 泼尼松能有效控制婴儿痉挛症的发作,早期治疗效果更好,IS患儿存在HPA轴功能紊乱,泼尼松能调节HPA轴功能紊乱起到控制痉挛发作的效果.     

Adrenocortical hyporesponsiveness after treatment with ACTH of infantile spasms.

The hypothalamic-pituitary-adrenocortical axis was studied in 10 infants before and during a six week period of treatment with adrenocorticotrophic hormone (ACTH) and three days and one and two weeks after its stopping. During the treatment 24 hour urinary cortisol excretion increased 20 to 350-fold (mean 100) above the basal value. Mean morning serum cortisol concentration, measured 24 hours after the preceding ACTH dose, did not increase. After the treatment mean urinary cortisol excretion was subnormal and mean morning serum cortisol concentration was below the pretreatment value. The mean serum cortisol response to a vasopressin test was reduced and shortened throughout the post-treatment observation period. The mean serum cortisol response to an intravenous ACTH test was not significantly different from the pretreatment response three days after treatment but was clearly reduced thereafter. At one and two weeks after treatment the basal concentrations of serum cortisol of one third of the patients and the post-ACTH concentrations of two thirds were subnormal. We conclude that in infants treatment with ACTH may cause adrenocortical hyporesponsiveness.