Tacke E, Kupferschmid C, Lang D
Klin Padiatr. 1983 Mar;195(2):124-8. doi: 10.1055/s-2008-1034055.
We report on two infants (two and six month old) with infantile myoclonic seizures, who developed signs of hypertrophic cardiomyopathy (HCM), while receiving ACTH treatment (Tetracosactid=Synacthen Depot). The diagnosis of HCM was established by echocardiography. The first patient (R.M. female). showed signs of cardiac insufficiency and was treated with a beta-blocking agent (Propranolol=Dociton). This led to resolution of the clinical symptoms and reversal of myocardial muscle thickness as determined by echocardiography. The second patient (R.S. female) did not develop cardiac symptoms. A correlation between cardiomyopathy and ACTH treatment is discussed. Based on the various biological effects of ACTH different hypothetical explanations for this correlation are proposed: increased deposition of glycogen, enhanced protein synthesis, oedema of the myocardial tissue and systemic hypertension. Because of the correlation observed between ACTH treatment and the development of cardiomyopathy we recommend regular physical and echocardiographic examinations to detect cardiac involvement during treatment with ACTH.
我们报告了两名患有婴儿肌阵挛性癫痫的婴儿（分别为2个月和6个月大），他们在接受促肾上腺皮质激素治疗（二十四肽促皮质素=长效合成促皮质素）时出现了肥厚型心肌病（HCM）的症状。HCM的诊断通过超声心动图确定。第一名患者（R.M.，女性）出现心脏功能不全的症状，接受了β受体阻滞剂（普萘洛尔=心得安）治疗。这导致临床症状得到缓解，并且超声心动图显示心肌厚度恢复正常。第二名患者（R.S.，女性）未出现心脏症状。文中讨论了心肌病与促肾上腺皮质激素治疗之间的相关性。基于促肾上腺皮质激素的各种生物学效应，针对这种相关性提出了不同的假设解释：糖原沉积增加、蛋白质合成增强、心肌组织水肿和系统性高血压。由于观察到促肾上腺皮质激素治疗与心肌病发展之间的相关性，我们建议在促肾上腺皮质激素治疗期间定期进行体格检查和超声心动图检查，以检测心脏受累情况。
