Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas

Abstract

To evaluate the short-and long-term adverse effects of systemic glucocorticosteroid (GS) therapy in infants with hemangiomas.Design: Retrospective chart review of infants treated with GSs for hemangiomas during a 3-year period.Setting: Tertiary care children's hospital Patients: Of 141 patients identified with hemangiomas, 22 were treated with GSs.Interventions: Minimum of 1-month GS therapy at a minimum starting dose of 0.5 mg/kg per day.Outcome Measures: Demographic and anthropometric measurements, starting dose and duration of GS therapy, subjective parental concerns, complications related to hemangioma, adjunctive treatment, and morning cortisol levels and/or results of corticotropin stimulation tests. Results:The average starting dose was 2.23 mg/kg per day; average length of therapy was 28.1 weeks. Complaints of irritability, fussiness, or insomnia were identified in 16 patients (73%). Hypertension, defined as 3 or more episodes of systolic blood pressure higher than 105 mm Hg, was observed in 10 patients (45%). Morning cortisol levels were abnormal in 13 (87%) of the 15 patients evaluated. Low-dose corticotropin stimulation test results were abnormal in 2 of the 3 infants tested.Conclusions: While GS therapy for infantile hemangiomas was tolerated well overall, changes in behavior, insomnia, and gastrointestinal symptoms were common parental concerns. Hypertension and hypothalamicpituitary-adrenal axis suppression were observed frequently. Infants undergoing long-term GS treatment of hemangiomas should be monitored carefully for these potential adverse effects.

Diagnosis and Management of Infantile Hemangioma

“…229 236 These include irritability, fussiness, insomnia, and personality changes. 230,234,236,237 Osteopenia is a known adverse effect of long-term systemic corticosteroid therapy but is rarely observed in children with IH, which presumably is related to the relatively short duration and nonrepetitive nature of therapy typically used for the treatment of IHs. Hypertension is also a risk of systemic corticosteroid therapy, but the percentage of affected individuals is unknown and is likely dose dependent.…”

Wnt3a Expression is Associated with MMP-9 Expression in Primary Tumor and Metastatic Site in Recurrent or Stage IV Colorectal Cancer

“…The standard treatment options for IH include corticosteroids or surgical excision, and the options in life-or sight-threatening cases include treatment with vincristine, interferon or cyclophosphamide. Unfortunately, none of these therapeutic modalities are ideal due to restrictions or potential serious side effects [4][5][6][7]. β-blockers have recently been introduced as a safe and effective treatment for IH [8][9][10][11].…”

Terapi Vincristine dan Triamcinolone dalam pengobatan Hemangioma Infantil

“…6,8,32,35 Terapi kortikosteroid oral jangka panjang dapat menimbulkan efek samping yang buruk seperti gangguan pertumbuhan, efek Cushingoid dan infeksi. [36][37][38] Efek samping lain dari kortikosteroid yang pernah dilaporkan adalah penekanan sistem immun dengan mengurangi migrasi neurophil ketempat peradangan, sebaiknya hindari pemberian vaksinasi kuman hidup terhadap pasien yang mendapat terapi jangka panjang kortikosteroid. 26 Aviles melaporkan adanya infeksi Pneumocystis carinii pada anak usia 3 bulan dengan HI setelah diberikan methyl prednisolon 3 m/kgbb/hari intravena selama 6 minggu.…”