BNF for Children 2011-2012

BNFC 2011–2012 6.4 Sex hormones 377Breast-feeding see notes aboveSide-effects see notes aboveIndication and doseAutoimmune inflammatory disorders (includingjuvenile idiopathic arthritis, connective tissuedisorders and systemic lupus erythematosus). By mouthChild 1 month–18 years initially 1–2 mg/kg oncedaily (usual max. 60 mg daily), then reduced after afew days if appropriateAutoimmune hepatitis. By mouthChild 1 month–18 years initially 2 mg/kg oncedaily (max. 40 mg daily) then reduced to minimumeffective doseCorticosteroid replacement therapy. By mouthChild 12–18 years 2–2.5 mg/m 2 daily in 1–2divided doses adjusted according to responseInfantile spasms. By mouthChild 1 month–2 years initially 10 mg 4 timesdaily for 14 days (if seizures not controlled after 7days increase to 20 mg 3 times daily for 7 days);reduce dose gradually over 15 days until stopped(patients taking 40 mg daily, reduce dose in stepsof 10 mg every 5 days, then stop; patients taking60 mg daily, reduce dose to 40 mg daily for 5 days,then 20 mg daily for 5 days, then 10 mg daily for 5days, then stop)Idiopathic thrombocytopenic purpura. By mouthChild 1–10 years 1–2 mg/kg daily for max. 14days or 4 mg/kg daily for max. 4 daysNephrotic syndrome. By mouthChild 1 month–18 years initially 60 mg/m 2 oncedaily (max. 80 mg daily) for 4–6 weeks until proteinuriaceases then 40 mg/m 2 on alternate daysfor 4–6 weeks, then withdraw by reducing dosegradually; prevention of relapse 0.5–1 mg/kg oncedaily or on alternate days for 3–6 monthsAsthma see p. 146Prednisolone (Non-proprietary) ATablets, prednisolone 1 mg, net price 28-tab pack =93p; 5 mg, 28-tab pack = £1.03; 25 mg, 56-tab pack =£30.00. Label: 10, steroid card, 21Tablets, both e/c, prednisolone 2.5 mg, net price 28-tab pack = £4.65, 100-tab pack = £30.79; 5 mg, 28-tabpack = £4.73, 100-tab pack = £31.04. Label: 5, 10,steroid card, 25Brands include Deltacortril cSoluble tablets, prednisolone 5 mg (as sodiumphosphate), net price 30-tab pack = £8.95. Label: 10,steroid card, 13, 216.4 Sex hormones6.4.1 Female sex hormones6.4.2 Male sex hormones and antagonists6.4.3 Anabolic steroidsSex hormone replacement therapy is indicated in childrenfor the treatment of gonadotrophin deficiency,gonadal disorders, or delayed puberty that interfereswith quality of life. Indications include constitutionaldelay in puberty, congenital or acquired hypogonadotrophichypogonadism, hypergonadotrophic hypogonadism(Turner’s syndrome, Klinefelter’s syndrome),endocrine disorders (Cushing’s syndrome or hyperprolactinaemia),and chronic illnesses, such as cystic fibrosisor sickle-cell disease, that may affect the onset ofpuberty.Replacement therapy is generally started at the appropriateage for the development of puberty and should bemanaged by a paediatric endocrinologist. Patients withconstitutional delay, chronic illness, or eating disordersmay need only small doses of hormone supplements for4 to 6 months to induce puberty and endogenous sexhormone production, which is then sustained. Patientswith organic causes of hormone deficiency will requirelife-long replacement, adjusted to allow normal development.Inadequate treatment may lead to poor bone mineralisation,resulting in fractures and osteoporosis.6.4.1 Female sex hormones6.4.1.1 Oestrogens6.4.1.2 Progestogens6 Endocrine systemEar section 12.1.1Eye section 11.4.1Immunosuppression section 8.2.2Inflammatory bowel disease section 1.5.2Pneumocystis pneumonia section 5.4.8Rheumatic disease section 10.1.26.4.1.1 OestrogensOestrogens are necessary for the development offemale secondary sexual characteristics. If onset ofpuberty is delayed because of organic pathology,puberty can be induced with ethinylestradiol in increasingdoses, guided by breast staging and uterine scans.Cyclical progestogen replacement is added after 12–18months of oestrogen treatment (see section 6.4.1.2).Once the adult dosage of oestrogen has been reached(20 micrograms ethinylestradiol daily), it may be moreconvenient to provide replacement either as a low-doseoestrogen containing oral contraceptive formulation