Reactions 1704, p317 - 2 Jun 2018 Various toxicities: 4 case reports In a retrospective review, four patients (3 boys and 1 girl) aged 6 8 months were described, of whom, one patient developed Cushingoid features and hirsutism, one patient developed adrenal insufficiency and one patient developed Cushingoid features during treatment with prednisolone, and the remaining one patient developed hyperirritability and increased blood pressure during treatment with tetracosactide [durations of treatments to reactions onsets and outcomes not stated]. Patient 1: The 6-months-old girl presented in October 2010, with a diagnosis of infantile spasms. She subsequently received an initial treatment. However, after two weeks, she again presented with no improvement in her seizures. Hence, she started receiving oral high dose prednisolone tablet 40 mg/day as per the United Kingdom infantile spasms study (UKISS) protocol. In the following seven days, her seizures stopped. Therefore, the prednisolone dose escalation was not required. However, she subsequently developed side effects of Cushingoid features and hirsutism. Patient 2: The 7-months-old boy presented in November 2012, with hypotonia. While assessing the hypotonia, he was diagnosed with infantile spasms. He subsequently started receiving oral high dose prednisolone tablet 40 mg/day as per the UKISS protocol. On day 4 of the treatment, his clinical spasms resolved, however, a the electrographic spasmcomplexes were persisted. Hence, the dose of prednisolone was increased to 60 mg/day in the second week, and then was tapered off subsequently. Considering the use of high dose steroid therapy, a short Synacthen test was performed, results of which revealed adrenal insufficiency. The adrenal insufficiency was suspected to be due to the use of high-dose steroids. Consequently, a replacement dose of steroids was administered. Patient 3: The 8-months-old boy presented in September 2013, with complaints of increasing frequency of clusters of extensor spasms, initiated in August 2013. He was subsequently diagnosed with infantile spasms, and started receiving oral high dose prednisolone tablet 40 mg/day as per the UKISS protocol. However, the clinical spasms persisted beyond the first week. Hence, the dose of prednisolone was increased to 60 mg/day in the second week. Following the dose escalation in week 2, the spasms resolved. He subsequently developed a side effect of Cushingoid features. Patient 4: The 7-months-old boy presented in August 2016, with clusters of extensor spasms. He was subsequently diagnosed with infantile spasms, and started receiving SC depot tetracosactide injection at 0.5mg on alternate days, as per the UKISS protocol. However, the spasms persisted with this dose. Additionally, he also developed side effects that included hyperirritability and raised blood pressure (raised up to 99 percentile). Although, the dose of tetracosactide was increased to 0.6mg, on alternate days. Author comment: "No serious side effects were documented with the exception of Cushingoid features and hirsutism [patient 1]." "Given the use of a very high dose steroid treatment. . .he was found to have adrenal insufficiency [patient 2]." "No severe side effect occurred except Cushingoid features [patient 3]." "[S]ide effects of [tetracosactide] occurred, including hyperirritability and blood pressure shooting up to 99 percentile [patient 4]." Yuen CL, et al. Local Experience in using Hormonal Therapies according to the UKISS Studies in the Treatment of Infantile Spasms in Hong Kong. Journal of Pediatric Epilepsy 7: 27-30, No. 1, Mar 2018. Available from: URL: http:// doi.org/10.1055/s-0038-1636947 - Hong Kong 803322912 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera