BNF for Children 2011-2012

382 6.5 Hypothalamic and pituitary hormones BNFC 2011–20126 Endocrine systemRenal impairment see Testosterone (section 6.4.2)Pregnancy see Testosterone (section 6.4.2)Breast-feeding see Testosterone (section 6.4.2)Side-effects see Testosterone (section 6.4.2)Indication and doseStimulation of late pre-pubertal growth in boyswith short stature. By mouthBoys 10–18 years (or appropriate age) 1.25–2.5 mg daily for 3–6 monthsStimulation of late pre-pubertal growth in girlswith Turner’s syndrome. By mouthGirls in combination with growth hormone 0.625–2.5 mg dailyOxandroloneTablets, oxandrolone 2.5 mgAvailable from ‘special-order’ manufacturers or specialistimporting companies, see p. 8096.5 Hypothalamic andpituitary hormones6.5.1 Hypothalamic and anterior pituitaryhormones including growth hormone6.5.2 Posterior pituitary hormones andantagonistsUse of preparations in these sections requiresdetailed prior investigation of the patient and shouldbe reserved for specialist centres.6.5.1 Hypothalamic andanterior pituitaryhormones includinggrowth hormoneAnterior pituitary hormonesCorticotrophinsTetracosactide (tetracosactrin), an analogue of corticotropin(adrenocorticotrophic hormone, ACTH), is usedto test adrenocortical function; failure of plasma-cortisolconcentration to rise after administration of tetracosactideindicates adrenocortical insufficiency. A low-dosetest is considered by some clinicians to be more sensitivewhen used to confirm established, partial adrenalsuppression.Tetracosactide should be used with caution in patientswith allergic disorders e.g. asthma and should be givenonly if no other ACTH preparations have been givenpreviously. Tetracosactide depot injection (SynacthenDepot c ) is also used in the treatment of infantile spasms(see Infantile spasms, section 4.8.1) but it is contraindicatedin neonates because of the presence of benzylalcohol in the injection. Corticotropin-releasing factor,corticorelin, (also known as corticotropin-releasinghormone, CRH) is used to test anterior pituitaryfunction and secretion of corticotropin.TETRACOSACTIDE(Tetracosactrin)Cautions as for corticosteroids, section 6.3.2; important:risk of anaphylaxis (medical supervision; consultproduct literature); interactions: Appendix 1 (corticosteroids)Contra-indications as for corticosteroids, section6.3.2; avoid injections containing benzyl alcohol inneonates (see under preparations)Hepatic impairment see section 6.3.2Renal impairment see section 6.3.2Pregnancy avoid (but may be used diagnostically ifessential)Breast-feeding avoid (but may be used diagnosticallyif essential)Side-effects as for corticosteroids, section 6.3.2Licensed use not licensed for low-dose test foradrenocortical insufficiency or treatment of infantilespasmsIndication and doseSee notes above and under preparations belowSynacthen c (Alliance) AInjection, tetracosactide 250 micrograms (asacetate)/mL. Net price 1-mL amp = £2.70DoseDiagnosis of adrenocortical insuffiency (30-minutetest). By intramuscular or intravenous injectionStandard-dose test 145 micrograms/m 2 (max.250 micrograms) as a single doseLow-dose test 300 nanograms/m 2 as a single doseAdministration may be diluted in sodium chloride 0.9%to 250 nanograms/mLSynacthen Depot c (Alliance) AInjection (aqueous suspension), tetracosactideacetate 1 mg/mL, with zinc phosphate complex. Netprice 1-mL amp = £3.87Excipients include benzyl alcohol (avoid in neonates, see Excipientsp. 2)DoseInfantile spasms. By intramuscular injectionChild 1 month–2 years initially 500 micrograms onalternate days, adjusted according to responseCORTICORELIN(Corticotrophin-releasing hormone, CRH)Pregnancy avoidBreast-feeding avoidSide-effects flushing of face, neck and upper body,hypotension, mild sensation of taste or smellLicensed use not licensed