Serum steroids and success of corticotropin therapy in infantile spasms.

Serum levels of 8 steroids and urinary cortisol excretion were determined in 10 infants before and during corticotropin therapy for infantile spasms. High serum dehydroepiandrosterone-androstenedione concentration ratio distinguished the 6 infants with good therapeutic response from the 4 with poor response (p = 0.001). No such distinction was obtained directly by any of the serum steroid levels, 24-hour urinary cortisol, or serum pregnenolone-progesterone concentration ratio. This suggests that the therapeutic effect of corticotropin may be mediated by steroid factors other than cortisol. Inhibition of the 3 beta-hydroxysteroid dehydrogenase system in zona reticularis might be beneficial during the corticotropin therapy.