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Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas
Manju E. George, MD;
Vidya Sharma, MD, MPH;
Jill Jacobson, MD;
Stephen Simon, PhD;
Amy Jo Nopper, MD
Arch Dermatol. 2004;140:963-969.
Objective 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 hypothalamic-pituitary-adrenal axis suppression were observed frequently. Infants undergoing long-term GS treatment of hemangiomas should be monitored carefully for these potential adverse effects.
From the Sections of Dermatology (Drs George, Sharma, and Nopper), Endocrinology (Dr Jacobson), and Research and Statistics (Dr Simon), Children's Mercy Hospital, Kansas City, Mo. The authors have no relevant financial interest in this article.
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