Glauser T A, Rogers M
Division of Neurology, Children's Hospital of Philadelphia, PA 19104.
J Child Neurol. 1990 Apr;5(2):111-3. doi: 10.1177/088307389000500207.
Adrenocorticotropic hormone (ACTH) is the treatment of choice for infantile spasms despite its multiple side effects. This case represents a previously unreported side effect, peptic ulceration, occurring during ACTH treatment of infantile spasms. Two pathophysiologic mechanisms are proposed and examined. A direct effect of ACTH on the duodenum is considered but deemed unlikely. Alternatively, the combination of the patient's communicating hydrocephalus and ACTH's central effects is proposed to have led to increased intracranial pressure and a Cushing's ulcer. The need for pretreatment neuroimaging and H2-receptor antagonist use during ACTH therapy in all cases, along with gastrin level measurements in selected cases, is recommended.
促肾上腺皮质激素（ACTH）是婴儿痉挛症的首选治疗药物，尽管它有多种副作用。本病例代表了一种先前未报道过的副作用，即婴儿痉挛症患者在接受ACTH治疗期间发生消化性溃疡。文中提出并探讨了两种病理生理机制。考虑到ACTH对十二指肠的直接作用，但认为这种可能性不大。另外，有人提出患者的交通性脑积水与ACTH的中枢效应相结合，导致颅内压升高和库欣溃疡。建议在所有ACTH治疗的病例中，治疗前进行神经影像学检查并使用H2受体拮抗剂，在部分病例中测量胃泌素水平。
