Growth, bone mineral accretion, and adrenal function in glucocorticoid-treated infants with hemangiomas-- a retrospective study.
Hemangiomas, common proliferative vascular tumors, can grow rapidly in the first months of life. Although therapy with high-dose oral glucocorticoids is standard for lesions that threaten vital functions or are disfiguring, little is known about the endocrine consequences of this treatment. Using retrospective data, we examined growth velocity, changes in bone mineral density, and adrenal function in infants with hemangiomas treated with systemic glucocorticoids. Treatment consisted of oral prednisolone 2 to 4 mg/kg/day or dexamethasone 1 mg/kg/day. Mean growth velocity Z score on glucocorticoid therapy was -1.41 standard deviations in 13 patients. In four infants with adequate follow-up, growth velocity increased to +1.90 standard deviations after glucocorticoid treatment (Delta growth velocity +3.31 standard deviations). Mean lumbar spine bone mineral density Z score was -2.46 standard deviations before glucocorticoid treatment and -1.08 standard deviations at the end of treatment in six infants. Adrenal function after glucocorticoid therapy was assessed by low-dose adrenocorticotropic hormone stimulation test in 10 infants. Eight had a normal cortisol response, and one had a borderline response. One infant, who had been treated with dexamethasone, had an abnormal test result. In conclusion, systemic glucocorticoid treatment in infants with hemangiomas slowed linear growth, but "catch-up" growth was observed after treatment ceased. Glucocorticoids did not affect bone mineralization adversely. Only 1 of 10 glucocorticoid-treated infants had clear evidence of adrenal insufficiency after therapy was stopped.
Lomenick
Jefferson P
JP
Hemangioma and Vascular Malformation Center, Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnait School of Medicine, Cincinnati, USA. jplome2@email.uky.edu
Backeljauw
Philippe F
PF
Lucky
Anne W
AW
D015502:Absorptiometry, Photon; D000311:Adrenal Glands / Q000187:drug effects*; D001827:Body Height; D002113:Calcification, Physiologic / Q000187:drug effects*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
D005938:Glucocorticoids