Analysis of ACTH Levels After High Dose and Long-Term Prednisone Therapy in Children with Steroid Sensitive Nephrotic Syndrome

Abstract

Background The use of high dose and long-term prednisone as glucocorticoid in steroid-sensitive nephrotic syndrome patients can cause the suppressive effect on endogenous steroid production, namely HPA axis suppression which is characterized by the decrease of ACTH levels. This can decrease cortisol levels so can affect metabolism process, immune response, and brain function. Objective To analyze ACTH levels in the induction and alternating phase, and to relate with the patient’s condition both clinical and laboratory data. Methods ACTH levels were measured before and after induction phase and four weeks after alternating phase at 08.00-09.30 a.m. Results 15 patients consisted of 9 boys and 6 girls showed there were no significant differences between ACTH levels in each phase. ACTH levels were increased 23.6% from 22.2 ± 13.1 pg/mL to 27.4 ± 23.0 pg/mL during the induction phase (p>0.05) and alternating phase also showed that ACTH levels were increased 1.7% from 27.4 ± 23.0 pg/mL to 27.9 ± 22.2 pg/mL (p>0.05). The clinical manifestation of HPA axis suppression such as hypoglycemia, hypotension, weight loss, appetite loss, and acute dehydration were not found in the patients. Weakness, fatigue, nausea, vomiting, and abdominal pain were found only 7% after the induction phase. Conclusion HPA axis suppression did not occur after the high dose and long-term prednisone therapy in the induction and alternating phase which showed ACTH levels average in normal range. It was also supported by the absence of clinical and laboratory data that showed signs of HPA axis suppression.