The use of hormonal therapy in pediatric heart disease
Brandon Nathan1, Joseph Sockalosky2, Lara Nelson1, Sarah Lai3, Consolato Sergi4, Anna Petryk1
1
University of Minnesota Children's Hospital, 516 Delaware St. S.E., Minneapolis, MN 55455, USA,2 Children's Hospitals and Clinics of Minnesota, 345 No. Smith Ave., St. Paul, MN 55102, USA, 3Department of Laboratory Medicine and Pathology, University of Alberta, 8440 - 112 Street, Edmonton, Alberta, Canada T6G 2B7, 4Institute of Pathology, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
TABLE OF CONTENTS
- 1. Abstract
- 2. Introduction
- 3. The effects of tri-iodothyronine in the pediatric post-operative cardiac patients
- 3.1. Introduction
- 3.2. Regulation of thyroid hormone secretion and the mechanism of action
- 3.3. Changes to thyroid hormone metabolism following cardiac surgery
- 3.4. Trials of thyroid hormone supplementation in post-operative cardiac patients
- 4. Fludrocortisone treatment for syncope
- 4.1. Introduction
- 4.2. The mechanism of action of fludrocortisone
- 4.3. Treatment for syncope
- 5. Corticosteroids after cardiopulmonary bypass
- 5.1. Introduction
- 5.2. The mechanism of anti-inflammatory action of corticosteroids
- 5.3. Peri-operative steroid administration
- 5.4. Post-operative steroid administration
- 6. Arginine-vasopressin in shock
- 5.1. Introduction
- 5.2. Regulation of arginine-vasopressin secretion and the mechanism of action
- 5.3. Therapeutic use of arginine-vasopressin in shock
- 7. The effect of growth hormone on cardiac function
- 6.1. Introduction
- 6.2. Regulation of growth hormone secretion and the mechanism of action
- 6.3. GH treatment of cardiac dysfunction in GH deficiency
- 6.4. GH treatment of heart failure due to dilated cardiomyopathy
- 8. Summary and perspective
- 9. References
1. ABSTRACT
The endocrine system plays an intricate role in the regulation and modulation of cardiovascular function. Several hormones including thyroid, mineralocorticoid, glucocorticoid, arginine-vasopressin (AVP), and growth hormone (GH) have been investigated as adjunctive therapies in pediatric cardiac disease. Thyroid hormone supplementation appears to be safe in neonatal and pediatric post-operative cardiac patients, but the benefits have been modest and inconsistent. Glucocorticoids appear to decrease the inflammatory response associated with cardiopulmonary bypass in children, but have little effect on clinical outcomes. The role of AVP in pediatric shock remains limited due to inconsistent trial results and its potential side effect profile. Although mineralcorticoids are commonly used to treat neurocardiogenic syncope, little to no benefit has been demonstrated in controlled trials. GH normalizes altered cardiac function in children who are GH deficient, but its effectiveness in the treatment of heart failure has been variable. Overall, the use of these hormones in a variety of pediatric cardiac conditions generally appears to be safe, but their efficacy for relieving symptoms, improving cardiac function, and improving clinical outcomes remains unclear.
