The Experts below are selected from a list of 27 Experts worldwide ranked by ideXlab platform
S G Ezhuthachan - One of the best experts on this subject based on the ideXlab platform.
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neonatal Cushingoid Syndrome resulting from serial courses of antenatal betamethasone
Obstetrics & Gynecology, 1994Co-Authors: B S Bradley, S P Kumar, P N Mehta, S G EzhuthachanAbstract:BACKGROUND: Antenatal steroid therapy has been shown to induce accelerated pulmonary maturation in preterm fetuses when delivery is imminent. Although this form of therapy has been used for 20 years, few studies or case reports have discussed the indications for or complications of retreatment, especially when more than two courses of steroids have already been given. We report a case of neonatal Cushingoid Syndrome with hypothalamic-pituitary-adrenal axis suppression following maternal treatment with seven courses of betamethasone. CASE: A 31-year-old white woman, gravida 3, para 1, spontaneous abortion 1, presented with a single intrauterine pregnancy at 24 weeks' gestation, a bulging amniotic sac, and repeated cerclage failure. Antenatal betamethasone therapy was begun at 12.5 mg intramuscularly every 12 hours for two doses. Because of cervical dilatation, bulging membranes, and intermittent contractions, the expectation of imminent premature delivery did not diminish over the next 42 days. As the effect of antenatal steroids wanes after 7 days, a course of therapy was administered each week for as long as the threat of preterm delivery remained. Seven courses of betamethasone were given before delivery at 34.5 weeks post-conception age. The 2625-g male neonate appeared Cushingoid on physical examination, with basal serum cortisol levels less than 3.3 micrograms/dL. CONCLUSION: Physical findings of the neonate and laboratory investigation of both infant and mother suggested combined hypothalamic-pituitary-adrenal axis suppression. The Cushingoid features of the infant demonstrate an undesired and previously unreported complication of an effective antenatal therapy. The unusual variant in this case was that the initial indication for steroid therapy (risk of premature delivery) persisted for 8 weeks after the first dose of betamethasone. It remains unknown how many weekly antenatal steroid courses can be administered before marked fetal adrenal suppression becomes evident. Risk-benefit ratios should be carefully considered before each retreatment.
B S Bradley - One of the best experts on this subject based on the ideXlab platform.
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neonatal Cushingoid Syndrome resulting from serial courses of antenatal betamethasone
Obstetrics & Gynecology, 1994Co-Authors: B S Bradley, S P Kumar, P N Mehta, S G EzhuthachanAbstract:BACKGROUND: Antenatal steroid therapy has been shown to induce accelerated pulmonary maturation in preterm fetuses when delivery is imminent. Although this form of therapy has been used for 20 years, few studies or case reports have discussed the indications for or complications of retreatment, especially when more than two courses of steroids have already been given. We report a case of neonatal Cushingoid Syndrome with hypothalamic-pituitary-adrenal axis suppression following maternal treatment with seven courses of betamethasone. CASE: A 31-year-old white woman, gravida 3, para 1, spontaneous abortion 1, presented with a single intrauterine pregnancy at 24 weeks' gestation, a bulging amniotic sac, and repeated cerclage failure. Antenatal betamethasone therapy was begun at 12.5 mg intramuscularly every 12 hours for two doses. Because of cervical dilatation, bulging membranes, and intermittent contractions, the expectation of imminent premature delivery did not diminish over the next 42 days. As the effect of antenatal steroids wanes after 7 days, a course of therapy was administered each week for as long as the threat of preterm delivery remained. Seven courses of betamethasone were given before delivery at 34.5 weeks post-conception age. The 2625-g male neonate appeared Cushingoid on physical examination, with basal serum cortisol levels less than 3.3 micrograms/dL. CONCLUSION: Physical findings of the neonate and laboratory investigation of both infant and mother suggested combined hypothalamic-pituitary-adrenal axis suppression. The Cushingoid features of the infant demonstrate an undesired and previously unreported complication of an effective antenatal therapy. The unusual variant in this case was that the initial indication for steroid therapy (risk of premature delivery) persisted for 8 weeks after the first dose of betamethasone. It remains unknown how many weekly antenatal steroid courses can be administered before marked fetal adrenal suppression becomes evident. Risk-benefit ratios should be carefully considered before each retreatment.
S P Kumar - One of the best experts on this subject based on the ideXlab platform.
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neonatal Cushingoid Syndrome resulting from serial courses of antenatal betamethasone
Obstetrics & Gynecology, 1994Co-Authors: B S Bradley, S P Kumar, P N Mehta, S G EzhuthachanAbstract:BACKGROUND: Antenatal steroid therapy has been shown to induce accelerated pulmonary maturation in preterm fetuses when delivery is imminent. Although this form of therapy has been used for 20 years, few studies or case reports have discussed the indications for or complications of retreatment, especially when more than two courses of steroids have already been given. We report a case of neonatal Cushingoid Syndrome with hypothalamic-pituitary-adrenal axis suppression following maternal treatment with seven courses of betamethasone. CASE: A 31-year-old white woman, gravida 3, para 1, spontaneous abortion 1, presented with a single intrauterine pregnancy at 24 weeks' gestation, a bulging amniotic sac, and repeated cerclage failure. Antenatal betamethasone therapy was begun at 12.5 mg intramuscularly every 12 hours for two doses. Because of cervical dilatation, bulging membranes, and intermittent contractions, the expectation of imminent premature delivery did not diminish over the next 42 days. As the effect of antenatal steroids wanes after 7 days, a course of therapy was administered each week for as long as the threat of preterm delivery remained. Seven courses of betamethasone were given before delivery at 34.5 weeks post-conception age. The 2625-g male neonate appeared Cushingoid on physical examination, with basal serum cortisol levels less than 3.3 micrograms/dL. CONCLUSION: Physical findings of the neonate and laboratory investigation of both infant and mother suggested combined hypothalamic-pituitary-adrenal axis suppression. The Cushingoid features of the infant demonstrate an undesired and previously unreported complication of an effective antenatal therapy. The unusual variant in this case was that the initial indication for steroid therapy (risk of premature delivery) persisted for 8 weeks after the first dose of betamethasone. It remains unknown how many weekly antenatal steroid courses can be administered before marked fetal adrenal suppression becomes evident. Risk-benefit ratios should be carefully considered before each retreatment.
P N Mehta - One of the best experts on this subject based on the ideXlab platform.
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neonatal Cushingoid Syndrome resulting from serial courses of antenatal betamethasone
Obstetrics & Gynecology, 1994Co-Authors: B S Bradley, S P Kumar, P N Mehta, S G EzhuthachanAbstract:BACKGROUND: Antenatal steroid therapy has been shown to induce accelerated pulmonary maturation in preterm fetuses when delivery is imminent. Although this form of therapy has been used for 20 years, few studies or case reports have discussed the indications for or complications of retreatment, especially when more than two courses of steroids have already been given. We report a case of neonatal Cushingoid Syndrome with hypothalamic-pituitary-adrenal axis suppression following maternal treatment with seven courses of betamethasone. CASE: A 31-year-old white woman, gravida 3, para 1, spontaneous abortion 1, presented with a single intrauterine pregnancy at 24 weeks' gestation, a bulging amniotic sac, and repeated cerclage failure. Antenatal betamethasone therapy was begun at 12.5 mg intramuscularly every 12 hours for two doses. Because of cervical dilatation, bulging membranes, and intermittent contractions, the expectation of imminent premature delivery did not diminish over the next 42 days. As the effect of antenatal steroids wanes after 7 days, a course of therapy was administered each week for as long as the threat of preterm delivery remained. Seven courses of betamethasone were given before delivery at 34.5 weeks post-conception age. The 2625-g male neonate appeared Cushingoid on physical examination, with basal serum cortisol levels less than 3.3 micrograms/dL. CONCLUSION: Physical findings of the neonate and laboratory investigation of both infant and mother suggested combined hypothalamic-pituitary-adrenal axis suppression. The Cushingoid features of the infant demonstrate an undesired and previously unreported complication of an effective antenatal therapy. The unusual variant in this case was that the initial indication for steroid therapy (risk of premature delivery) persisted for 8 weeks after the first dose of betamethasone. It remains unknown how many weekly antenatal steroid courses can be administered before marked fetal adrenal suppression becomes evident. Risk-benefit ratios should be carefully considered before each retreatment.
Pierre Cochat - One of the best experts on this subject based on the ideXlab platform.
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Triamcinolone acetonide: a new management of noncompliance in nephrotic children
Pediatric Nephrology, 2005Co-Authors: Tim Ulinski, Anne Carlier-legris, Déborah Schlecht, Bruno Ranchin, Pierre CochatAbstract:Noncompliance is frequent in children and adolescents with nephrotic Syndrome. Once suspected, noncompliance is difficult to confirm and often impossible to avoid. The standard oral glucocorticoid treatment for children has been shown to be efficient and safe. However, a small number of children/parents are noncompliant to the steroid treatment, resulting in multiple relapses. For these patients the use of steroids with prolonged half-life such as triamcinolone acetonide (TA) can be helpful. We studied seven children (six boys, one girl; median age at diagnosis 8.6 years, range 1.8–10.7) receiving conventional steroid treatment for a median of 30 months (8−74) before starting intramuscular (IM) TA treatment. The standard prednisone treatment was replaced by 1 monthly IM injection of TA (1 mg/kg per day oral prednisone replaced by 1 mg/kg per month IM TA). The treatment was tapered off by a reduction of 10–20% of the initial dose per month over 6–8 months. After a mean observation period of 14 months (3–36) the results were evaluated in terms of number of relapses and treatment tolerance. Four children showed a clear decrease in number of relapses (1.8 to 0 per year); in the other three the number of relapses remained stable. Tolerance was excellent (no cataract, no arterial hypertension), and the Cushingoid Syndrome did not exceed the level experienced under conventional oral steroid therapy. However, growth velocity decreased during the TA treatment and returned to normal after discontinuation of TA. These preliminary results demonstrate that TA may be used in patients of suspected noncompliance in steroid-sensitive patients who respond with a complete remission during TA treatment over the observation period. Patients who do not benefit from the TA can be classified as very probably steroid-dependent. TA seems to be a useful therapeutic strategy in those patients for whom noncompliance is strongly suspected.
