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

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.

Anahtar Kelimeler

• Epileptic encephalopathy
• West syndrome
• Adrenocorticotropic hormone

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

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.

Anahtar Kelimeler

• Epileptik ensefalopati
• West sendromu
• Adrenokortikotropik hormon

Kaynakça

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