title: Recurrent exacerbations of protein-losing enteropathy after initiation of growth hormone therapy in a Fontan patient controlled with spironolactone.
abstract: Protein-losing enteropathy (PLE) is a rare, but serious complication in single ventricle patients after Fontan palliation, and is associated with a 5-year mortality of 46%. We describe a patient with PLE after Fontan palliation who achieved remission with high-dose spironolactone (an aldosterone antagonist), but had three exacerbations each temporally correlated with the use of growth hormone (an aldosterone agonist). Because of the opposing mechanisms of action of these two medications, caution might be indicated when using growth hormone for patients with PLE who are successfully treated with spironolactone.
authors.affiliation: Department of Pediatrics, Division of Cardiology, University of Toronto, The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Grattan
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D000450:Aldosterone / Q000819:agonists; D018729:Fontan Procedure / Q000009:adverse effects*; D006130:Growth Disorders / Q000150:complications / Q000188:drug therapy*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D019382:Human Growth Hormone / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010166:Palliative Care; D011504:Protein-Losing Enteropathies / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D012008:Recurrence; D012074:Remission Induction; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D019382:Human Growth Hormone; D013148:Spironolactone; D000450:Aldosterone