title: Vincristine for successful treatment of steroid-dependent infantile hemangiomas.
abstract: Infantile hemangiomas (IHs) are common, although systemic therapy has been generally limited to circumstances of potential compromise of vital functions (airway, vision, feeding, or cardiac), risk of disfigurement, or bleeding. IHs have previously been shown to express high levels of type III deiodinase, which catabolizes active thyroid hormone, resulting in a state of severe hypothyroidism, termed "consumptive hypothyroidism." We describe an infant with diffuse hepatic hemangiomas who developed consumptive hypothyroidism who was initially treated successfully with systemic glucocorticoids and β-blockers. Several efforts to wean her medications were unsuccessful. She subsequently developed severe growth restriction and treatment alternatives were sought. Although previously limited to treatment of life-threatening hemangiomas, a trial of vincristine was initiated. She was ultimately weaned from all systemic therapies, with recovery of a normal growth trajectory. This case highlights broader indications for vincristine as a safe and effective systemic therapy for treatment of IHs. It also stresses the importance of close anthropometric monitoring of infants and toddlers receiving glucocorticoid therapy and intervention when growth compromise becomes evident.
authors.affiliation: Divisions of Endocrinology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada jonathan.wasserman@sickkids.ca.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Wasserman
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada Pediatric Medicine, and.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada Hematology/Oncology, and.
authors.forename: Manuel
authors.initials: M
authors.lastname: Carcao
authors.affiliation: Divisions of Endocrinology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kusiel
authors.initials: K
authors.lastname: Perlman
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada Pediatric Medicine, and Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; and.
authors.forename: Elena
authors.initials: E
authors.lastname: Pope
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007037:Hypothyroidism; D007223:Infant; D008113:Liver Neoplasms / Q000188:drug therapy*; D012074:Remission Induction; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D005938:Glucocorticoids; D014750:Vincristine