Adverse Effects of Ramadan Fasting in a Girl with Salt-Losing Congenital Adrenal Hyperplasia.

Autor: Calcaterra V; Pediatric and Adolescent Unit, Department of Internal Medicine University of Pavia, Pavia, Italy.; Department of Pediatrics, Children' Hospital 'Vittore Buzzi', Milan, Italy., Bassanese F; Pediatric Unit, Department of the Mother and Child Health Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy., Clemente AM; Pediatric Unit, Department of the Mother and Child Health Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy., Amariti R; Pediatric and Adolescent Unit, Department of Internal Medicine University of Pavia, Pavia, Italy.; Pediatric Unit, Department of the Mother and Child Health Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy., Regalbuto C; Pediatric Unit, Department of the Mother and Child Health Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy., Sala A; Department of Pediatrics, Children' Hospital 'Vittore Buzzi', Milan, Italy.; Department of Biomedical and Clinical Science 'L. Sacco', University of Milano, Milano, Italy., Zuccotti GV; Department of Pediatrics, Children' Hospital 'Vittore Buzzi', Milan, Italy.; Department of Biomedical and Clinical Science 'L. Sacco', University of Milano, Milano, Italy.
Jazyk: angličtina
Zdroj: Case reports in endocrinology [Case Rep Endocrinol] 2020 Dec 29; Vol. 2020, pp. 6688927. Date of Electronic Publication: 2020 Dec 29 (Print Publication: 2020).
DOI: 10.1155/2020/6688927
Abstrakt: Objective: Congenital adrenal hyperplasia (CAH) is the most common cause of adrenal insufficiency in pediatrics. Chronic glucocorticoid replacement is the mainstay of treatment in the classic forms of CAH, and mineralocorticoid replacement therapy is mandatory in the salt-wasting form. Fasting is a mild stressor, which can expose to dehydration, hypotension, hypoglycemia, and acute adrenal crisis in patients with adrenal insufficiency.
Case: We report the case of an adolescent affected by the classic form with salt-losing CAH, who observed Ramadan for 30 days, without individualized therapeutic management plan. After Ramadan, a dramatic increase of ACTH level (1081 pg/ml, n.v. 6-57), reduced cortisolemia, tendency to hypotension, and weight loss were recorded. She experienced insomnia, intense thirst, asthenia, and headache. The symptoms disappeared restarting the previous therapy schedule and increasing the total hydrocortisone daily dose with progressive restoring of hormonal control.
Conclusion: Our case confirms that patients with CAH are vulnerable, especially during fasting in Ramadan, with a higher risk of acute adrenal crisis. CAH patients should reform and individualize their treatment plan and be submitted to careful monitoring.
Competing Interests: The authors declare that they have no conflicts of interest.
(Copyright © 2020 Valeria Calcaterra et al.)
Databáze: MEDLINE
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