Background - Infantile spasm (IS) is one of the most recognized types of epileptic encephalopathy. Early treatment with ACTH can improve outcome. The risk for adrenal insufficiency due to prolonged exposure to exogenous glucocorticoids is a well-known phenomenon, related to the suppression of the hypothalamus-pituitary-adrenal (HPA) axis. Few studies with small numbers of patients investigated the risk of suppression of the HPA axis following treatment with ACTH for IS. Our objective was to determine the incidence of adrenal insufficiency secondary to ACTH treatment in IS patients.
Methods - A retrospective study including children diagnosed with IS between 2007-2018, treated with ACTH and were followed at the "Soroka University Medical Center" (SUMC). Children were included if they had a post treatment laboratory assessment of the HPA axis. Children diagnosed with congenital panhypopituitarism were excluded. Data extracted from the computerized database in SUMC. Descriptive analysis calculations included distribution of single variable, central tendency and dispersion.
Results - During the study period 14 children were diagnosed with IS and had a laboratory assessment of the HPA axis following treatment. . Five of the patients went through a low dose ACTH test, while the other nine had a morning spot cortisol level. No patient found to be with adrenal insufficiency.
Conclusion – The incidence for adrenal insufficiency following ACTH treatment in IS patients is very low. Further multi-center studies need to be done in the future.
