Klinik Araştırma
BibTex RIS Kaynak Göster

Evaluation of the short-term effects on bone mineral metabolism and the adrenal pathway of adrenocorticotropic hormone therapy used in epileptic encephalopathy

Yıl 2023, , 146 - 152, 31.01.2023
https://doi.org/10.16899/jcm.1222558

Öz

Background: We aimed to investigate the short-term effects of adrenocorticotropic hormone (ACTH) treatment on the adrenal pathway and bone metabolism in patients with epileptic encephalopathy.
Methods: Two groups with 16 patients and 16 controls were formed. Before the treatment, all patients and controls were tested for bone and adrenal metabolism. Twenty doses of ACTH therapy were given to the patient group over 3 months. The tests on the patient group were repeated 1 month after the end of the treatment.
Results: In the patient group, serum calcium, phosphorus and parathyroid hormone levels increased significantly after treatment compared with before treatment. Comparing the bone metabolism of the patient and control groups, urinary calcium/creatinine ratio was higher before treatment; serum phosphorus level, bone-specific alkaline phosphatase level and the urinary calcium/creatinine ratio were higher after treatment in the patient group. In the evaluation of the adrenal pathway, no significant differences were found between fasting serum glucose, sodium, potassium, cortisol and ACTH levels before and after treatment and in the comparison of the patient and control groups.
Conclusion: Our study investigated the short-term effect of ACTH on the adrenal pathway and bone metabolism. The results show that ACTH treatment did not have a negative effect on the adrenal pathway in the early period but, its effects on bone metabolism have not been adequately clarified.

Kaynakça

  • 1. Scheffer IE, Liao J. Deciphering the concepts behind “Epileptic encephalopathy” and “Developmental and epileptic encephalopathy”. Eur J Paediatr Neurol. 2020; 24:11–14. DOI: 10.1016/j.ejpn.2019.12.023
  • 2. Wright SK, Wood AG. Neurodevelopmental outcomes in paediatric immune-mediated and autoimmune epileptic encephalopathy. Eur J Paediatr Neurol. 2020; 24:53–57. DOI: 10.1016/j.ejpn.2019.12.010
  • 3. Hancock EC, Osborne JP, Edwards SW. Treatment of infantile spasms. Cochrane Database Syst Rev. 2013;(6):CD001770. DOI: 10.1002/14651858.CD001770.pub3
  • 4. Shumiloff NA, Lam WM, Manasco KB. Adrenocorticotropic hormone for the treatment of West Syndrome in children. Ann Pharmacother. 2013; 47:744–754. DOI: 10.1345/aph.1R535
  • 5. Riikonen R, Donner M. ACTH therapy in infantile spasms: side effects. Arch Dis Child. 1980; 55:664–672. DOI: 10.1136/adc.55.9.664
  • 6. Pavone P, Polizzi A, Marino SD, et al. West syndrome: a comprehensive review. Neurol Sci. 2020; 41:3547-3562. DOI: 10.1007/s10072-020-04600-5
  • 7. Özdemir AA, Ercan Gündemir Y, Küçük M, et al. Vitamin D deficiency in pregnant women and their infants. J Clin Res Pediatr Endocrinol. 2018; 10:44–50. DOI: 10.4274/jcrpe.4706
  • 8. Landry BW, Driscoll SW. Physical activity in children and adolescents. PM&R 2012; 4:826–832. DOI: 10.1016/j.pmrj.2012.09.585
  • 9. Tasdemir HA, Buyukavci M, Akcay F, Polat P, Yildiran A, Karakelleoglu C. Bone mineral density in children with cerebral palsy. Pediatr Int. 2001; 43:157–160. DOI: 10.1046/j.1442-200x.2001.01352.x
  • 10. Cooper MS. Glucocorticoids in bone and joint disease: the good, the bad and the uncertain. Clin Med. 2012; 12:261–265. DOI: 10.7861/clinmedicine.12-3-261
  • 11. Falhammar H, Nyström HF, Wedell A, Brismar K, Thorén M. Bone mineral density, bone markers, and fractures in adult males with congenital adrenal hyperplasia. Eur J Endocrinol. 2013; 168:331–341. DOI: 10.1530/EJE-12-0865
  • 12. Riikonen R, Simell O, Jääskeläinen J, Rapola J, Perheentupa J. Disturbed calcium and phosphate homeostasis during treatment with ACTH of infantile spasms. Arch Dis Child. 1986; 61:671–676. DOI: 10.1136/adc.61.7.671
  • 13. Duzen O, Erkoc R, Begenik H, Soyoral YU, Aldemir MN. The course of hypercalciuria and related markers of bone metabolism parameters associated with corticosteroid treatment. Ren Fail. 2012; 34:338–342. DOI: 10.3109/0886022X.2011.648596
  • 14. Koşan C, Ayar G, Orbak Z. Effects of steroid treatment on bone mineral metabolism in children with glucocorticoid-sensitive nephrotic syndrome. West Indian Med J. 2012; 61:627–630.
  • 15. Miyahara H, Akiyama T, Hasegawa K, et al. Laboratory changes during adrenocorticotropic hormone therapy associated with renal calcified lesions. Pediatr Int. 2020; 62:587–592. DOI: 10.1111/ped.14158
  • 16. Kruse K, Büsse M, Kracht U, Kruse U, Wohlfart K. Disorders of calcium and bone metabolism in glucocorticoid treatment. Monatsschrift Kinderheilkd Organ Dtsch Ges Kinderheilkd. 1988; 136:237-242.
  • 17. Cooper MS, Hewison M, Stewart PM. Glucocorticoid activity, inactivity and the osteoblast. J Endocrinol. 1999; 163:159–164. DOI: 10.1677/joe.0.1630159
  • 18. Yamamoto T. Latent adrenal insufficiency: concept, clues to detection, and diagnosis. Endocr Pract. 2018; 24:746–755. DOI: 10.4158/EP-2018-0114
  • 19. Perheentupa J, Riikonen R, Dunkel L, Simell O. Adrenocortical hyporesponsiveness after treatment with ACTH of infantile spasms. Arch Dis Child. 1986; 61:750–753. DOI: 10.1136/adc.61.8.750

Epileptik ensefalopatide kullanılan adrenokortikotropik hormonun kemik mineral metabolizması ve adrenal yolak üzerine kısa dönem etkilerinin değerlendirilmesi

Yıl 2023, , 146 - 152, 31.01.2023
https://doi.org/10.16899/jcm.1222558

Öz

Amaç: Epileptik ensefalopatili hastalarda adrenokortikotropik hormon (ACTH) tedavisinin adrenal yolak ve kemik metabolizması üzerine kısa dönemli etkilerini araştırmayı amaçladık.
Yöntem: 16 hasta ve 16 kontrolden oluşan iki grup oluşturuldu. Tedavi öncesi tüm hasta ve kontrollere kemik ve adrenal metabolizma testleri yapıldı. Hasta grubuna 3 ay boyunca 20 doz ACTH tedavisi verildi. Hasta grubundaki testler tedavi bitiminden 1 ay sonra tekrarlandı.
Bulgular: Hasta grubunda tedavi öncesine göre tedavi sonrası serum kalsiyum, fosfor ve paratiroid hormon düzeyleri anlamlı olarak yükseldi. Hasta ve kontrol gruplarının kemik metabolizması karşılaştırıldığında, tedavi öncesi idrar kalsiyum/kreatinin oranı daha yüksekti; hasta grubunda tedavi sonrası serum fosfor düzeyi, kemiğe özgü alkalin fosfataz düzeyi ve idrar kalsiyum/kreatinin oranı daha yüksekti. Adrenal yolun değerlendirilmesinde, tedavi öncesi ve sonrası açlık serum glukozu, sodyum, potasyum, kortizol ve ACTH düzeyleri arasında ve hasta ve kontrol grupları karşılaştırıldığında anlamlı fark bulunmadı.
Sonuç: Çalışmamız ACTH'nin adrenal yol ve kemik metabolizması üzerindeki kısa vadeli etkisini araştırdı. Sonuçlar, ACTH tedavisinin erken dönemde adrenal yolak üzerinde olumsuz bir etkisinin olmadığını ancak kemik metabolizması üzerindeki etkilerinin yeterince aydınlatılmadığını göstermektedir.

Kaynakça

  • 1. Scheffer IE, Liao J. Deciphering the concepts behind “Epileptic encephalopathy” and “Developmental and epileptic encephalopathy”. Eur J Paediatr Neurol. 2020; 24:11–14. DOI: 10.1016/j.ejpn.2019.12.023
  • 2. Wright SK, Wood AG. Neurodevelopmental outcomes in paediatric immune-mediated and autoimmune epileptic encephalopathy. Eur J Paediatr Neurol. 2020; 24:53–57. DOI: 10.1016/j.ejpn.2019.12.010
  • 3. Hancock EC, Osborne JP, Edwards SW. Treatment of infantile spasms. Cochrane Database Syst Rev. 2013;(6):CD001770. DOI: 10.1002/14651858.CD001770.pub3
  • 4. Shumiloff NA, Lam WM, Manasco KB. Adrenocorticotropic hormone for the treatment of West Syndrome in children. Ann Pharmacother. 2013; 47:744–754. DOI: 10.1345/aph.1R535
  • 5. Riikonen R, Donner M. ACTH therapy in infantile spasms: side effects. Arch Dis Child. 1980; 55:664–672. DOI: 10.1136/adc.55.9.664
  • 6. Pavone P, Polizzi A, Marino SD, et al. West syndrome: a comprehensive review. Neurol Sci. 2020; 41:3547-3562. DOI: 10.1007/s10072-020-04600-5
  • 7. Özdemir AA, Ercan Gündemir Y, Küçük M, et al. Vitamin D deficiency in pregnant women and their infants. J Clin Res Pediatr Endocrinol. 2018; 10:44–50. DOI: 10.4274/jcrpe.4706
  • 8. Landry BW, Driscoll SW. Physical activity in children and adolescents. PM&R 2012; 4:826–832. DOI: 10.1016/j.pmrj.2012.09.585
  • 9. Tasdemir HA, Buyukavci M, Akcay F, Polat P, Yildiran A, Karakelleoglu C. Bone mineral density in children with cerebral palsy. Pediatr Int. 2001; 43:157–160. DOI: 10.1046/j.1442-200x.2001.01352.x
  • 10. Cooper MS. Glucocorticoids in bone and joint disease: the good, the bad and the uncertain. Clin Med. 2012; 12:261–265. DOI: 10.7861/clinmedicine.12-3-261
  • 11. Falhammar H, Nyström HF, Wedell A, Brismar K, Thorén M. Bone mineral density, bone markers, and fractures in adult males with congenital adrenal hyperplasia. Eur J Endocrinol. 2013; 168:331–341. DOI: 10.1530/EJE-12-0865
  • 12. Riikonen R, Simell O, Jääskeläinen J, Rapola J, Perheentupa J. Disturbed calcium and phosphate homeostasis during treatment with ACTH of infantile spasms. Arch Dis Child. 1986; 61:671–676. DOI: 10.1136/adc.61.7.671
  • 13. Duzen O, Erkoc R, Begenik H, Soyoral YU, Aldemir MN. The course of hypercalciuria and related markers of bone metabolism parameters associated with corticosteroid treatment. Ren Fail. 2012; 34:338–342. DOI: 10.3109/0886022X.2011.648596
  • 14. Koşan C, Ayar G, Orbak Z. Effects of steroid treatment on bone mineral metabolism in children with glucocorticoid-sensitive nephrotic syndrome. West Indian Med J. 2012; 61:627–630.
  • 15. Miyahara H, Akiyama T, Hasegawa K, et al. Laboratory changes during adrenocorticotropic hormone therapy associated with renal calcified lesions. Pediatr Int. 2020; 62:587–592. DOI: 10.1111/ped.14158
  • 16. Kruse K, Büsse M, Kracht U, Kruse U, Wohlfart K. Disorders of calcium and bone metabolism in glucocorticoid treatment. Monatsschrift Kinderheilkd Organ Dtsch Ges Kinderheilkd. 1988; 136:237-242.
  • 17. Cooper MS, Hewison M, Stewart PM. Glucocorticoid activity, inactivity and the osteoblast. J Endocrinol. 1999; 163:159–164. DOI: 10.1677/joe.0.1630159
  • 18. Yamamoto T. Latent adrenal insufficiency: concept, clues to detection, and diagnosis. Endocr Pract. 2018; 24:746–755. DOI: 10.4158/EP-2018-0114
  • 19. Perheentupa J, Riikonen R, Dunkel L, Simell O. Adrenocortical hyporesponsiveness after treatment with ACTH of infantile spasms. Arch Dis Child. 1986; 61:750–753. DOI: 10.1136/adc.61.8.750
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Mesut Güngör 0000-0003-1594-0006

Bengü Altınordu 0000-0002-7955-3067

Hülya Maraş Genç 0000-0001-8869-0277

Emek Uyur Yalçın 0000-0001-6071-6375

Filiz Mine Çizmecioğlu Jones 0000-0001-7340-6368

Bülent Kara 0000-0003-3780-6596

Yayımlanma Tarihi 31 Ocak 2023
Kabul Tarihi 3 Ocak 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

AMA Güngör M, Altınordu B, Maraş Genç H, Uyur Yalçın E, Çizmecioğlu Jones FM, Kara B. Evaluation of the short-term effects on bone mineral metabolism and the adrenal pathway of adrenocorticotropic hormone therapy used in epileptic encephalopathy. J Contemp Med. Ocak 2023;13(1):146-152. doi:10.16899/jcm.1222558