Background: Hormonal therapy is a standard
treatment for infantile spasms. The high doses given and long treatment
duration expose patients to the risk of adrenal insufficiency (AI). This
study aims to quantify the incidence of AI among children with infantile
spasms treated with corticosteroids and/or adrenocorticotropic hormone
(ACTH). Methods: A retrospective chart review of
patients treated for infantile spasms was performed between January 2009 to
March 2020 in one pediatric specialized hospital. Variables collected
included patient and treatment characteristics, risk factors of AI and
adrenal function testing. Analysis included descriptive statistics.
Results: Thirty-one patients met the inclusion
criteria and received a total of 33 separated courses of treatment. Adrenal
function following each course of treatment was evaluated in all patients.
AI occurred in 25/33 (76% [95CI 58-89]) children. There was no predictive
factor of AI. No drug regimen was deemed safe. The two patients (6%) with an
acute adrenal crisis were the youngest of the cohort.
Conclusions: Adrenal suppression is frequent and
can lead to adrenal crisis after standard hormonal therapy for infantile
spasms. A routine laboratory assessment of adrenal function should be done
for all patients. Hydrocortisone replacement therapy should be given until
testing results are obtained, particularly for younger infants.
Adrenal Function Testing Following Hormone Therapy for Infantile Spasms: Case Series and Review of Literature
