Terapêutica hormonal na coréia de Sydenham

Albernaz, José Geraldo; Carmo, Romualdo José do

doi:10.1590/S0004-282X1957000300003

Resumos

Cinco casos de coréia de Sydenham foram submetidos à terapêutica hormonal com Cortisona, Prednisona e Prednisolona; o fenobarbital e a clorpromazina foram utilizados como medicação sintomática e a Penicilina-Benzatina como profilática. Depois de analisadas as referências bibliográficas, comparados os resultados de ν;rios autores, e ajuizados os resultados obtidos em nossos casos, acreditamos poder concluir que: 1) a terapêutica hormonal da coréia de Sydenham, com o uso de ACTH, Cortisona, Prednisona ou Pred-nisclona apresenta resultados satisfatórios; 2) a Prednisona e a Prednisolona são os hormônios mais úteis no tratamento da coréia de Sydenham, sendo possível que sua associação aos salicilatos permita obter resultados ainda melhores; 3) o tratamento deve prolongar-se até o completo desaparecimento dos sintomas, as doses variando de acôrdo com a gravidade e a evolução da moléstia; 4) a terapêutica hormonal deve ser usada sem prejuízo de medicação sintomática (sedativa) e profilática (antibiótica).

Five cases of Sydenham's chorea were treated with Cortisone, Prednisone and/or Prednisolone; Phenobarbital and Chlorpromazine were used as symptomatic and Benzathine-Penicillin as prophylatic medications. Reports of other workers were analyzed and their results compared. It is believed that the following conclusions are justified: 1) hormonal therapy of Sydenham's chorea with ACTH, Cortisone, Prednisone or Prednisolone brings satisfactory results; 2) Prednisone and Prednisolone are the most useful hormones for treatment of Sydenham's chorea, their association with salicylates possibly promising even better results; 3) treatment should be continued until symptoms disappear and the dosage should be individualized according to the severity and progression of the disease; 4) hormonal therapy should be done together with symptomatic (sedatives) and prophylatic (antibiotics) medications.

José Geraldo Albernaz^I; Romualdo José do Carmo^II

^ILivre-Docente de Clinica Neurológica da Faculdade de Medicina da Universidade de Minas Gerais, em exercício da Cátedra; diplomado pelo American Board of Neurological Surgery; Chefe do Serviço de Neurologia e Neurocirurgia do Hospital "Felicio Roxo" (Belo Horizonte, Minas Gerais)

^IIAssistente voluntário da Clínica Neurológica da Faculdade de Medicina da Universidade de Minas Gerais (Belo Horizonte, Minas Gerais)

RESUMO

Cinco casos de coréia de Sydenham foram submetidos à terapêutica hormonal com Cortisona, Prednisona e Prednisolona; o fenobarbital e a clorpromazina foram utilizados como medicação sintomática e a Penicilina-Benzatina como profilática. Depois de analisadas as referências bibliográficas, comparados os resultados de ν;rios autores, e ajuizados os resultados obtidos em nossos casos, acreditamos poder concluir que: 1) a terapêutica hormonal da coréia de Sydenham, com o uso de ACTH, Cortisona, Prednisona ou Pred-nisclona apresenta resultados satisfatórios; 2) a Prednisona e a Prednisolona são os hormônios mais úteis no tratamento da coréia de Sydenham, sendo possível que sua associação aos salicilatos permita obter resultados ainda melhores; 3) o tratamento deve prolongar-se até o completo desaparecimento dos sintomas, as doses variando de acôrdo com a gravidade e a evolução da moléstia; 4) a terapêutica hormonal deve ser usada sem prejuízo de medicação sintomática (sedativa) e profilática (antibiótica).

SUMMARY

Five cases of Sydenham's chorea were treated with Cortisone, Prednisone and/or Prednisolone; Phenobarbital and Chlorpromazine were used as symptomatic and Benzathine-Penicillin as prophylatic medications. Reports of other workers were analyzed and their results compared. It is believed that the following conclusions are justified: 1) hormonal therapy of Sydenham's chorea with ACTH, Cortisone, Prednisone or Prednisolone brings satisfactory results; 2) Prednisone and Prednisolone are the most useful hormones for treatment of Sydenham's chorea, their association with salicylates possibly promising even better results; 3) treatment should be continued until symptoms disappear and the dosage should be individualized according to the severity and progression of the disease; 4) hormonal therapy should be done together with symptomatic (sedatives) and prophylatic (antibiotics) medications.

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REFERÊNCIAS

1. AINGER, L. E.; ELY, R. S.; DONE, A. K.; BRILL, A. B.; KELLY, V. C. - a) Sydenham's chorea: Evidence of abnormal adrenal cortex function. Am. J. Dis. Child., 89:575, 1955; b) Sydenham's chorea: Effects of hormone therapy. Am. J. Dis. Child., 89:580, 1955.

2. ARONSON, N.; DOUGLAS, H. S.; LEWIS, J. M. - Cortisone in Sydenham's chorea: report of 2 cases. J.A.M.A., 145:30, 1951.

3. BLAND, E. F.; JONES, T. D. - The natural history of rheumatic fever: a 20 year perspective. Ann. Int. Med., 37:1006, 1952.

4. BUNIM, J. J. - The clinical effects of Cortisone and ACTH on rheumatic disease. Bull. New York Acad. Med., 27:75, 1951.

5. CUTLER, M. - Cortisone dosage in Sydenham's chorea. J. Med. Soc. New Jersey, 48:226, 1951.

6. DORDICK, J. R.; GLUCK, E. J. - Preliminary clinical trials with Prednisone (Meticorten) in rheumatic diseases: comparative antirheumatic potency, metabolic activity and hormonal properties. J.A.M.A., 158:166, 155.

7. GLASSER, G. H.; MERRIT, H. H. - Effects of Corticotropin (ACTH) and Cortisone on disorders of the nervous system. J.A.M.A., 148:898, 1952.

8. HENCH, P. S.; KENDALL, E. C; SLOCUMB, C. H.; POLLEY, H. F. - Effect of hormone of adrenal cortex (17-hydroxydehydroeorticosterone: compound E) and of pituitary adrenocorticotropin hormone on rheumatoid arthritis. Proc. Staff Meet. Mayo Clin., 24:181, 1949.

9. HENCH, P. S.; SLOCUMB, C. H.; BARNES, A. R.: SMITH, H. L.; POLLEY, H. F.; KENDALL, E. C. - Effects of adrenal cortical hormone 17-hydroxydehydrocorticosterone (compound E) on acute phase of rheumatic fever. Proc. Staff Meet. Mayo Clin., 24:277, 1949.

10. HOLT, K. S.; ILLINGWORTH, R. S.; LORBER, J.; RENDLE-SHORT, J. - Cortisone and salicylates in rheumatic fever. Lancet, 2:1144, 1954.

11. JONES, F. D. - The diagnosis of rheumatic fever. J.A.M.A., 126:481, 1944.

12. KELLY, V. C. - Corticotropin (ACTH) therapy of initial attacks of acute rheumatic fever in children. Am. J. Dis. Child., 84:151, 1952.

13. KREIDBERG, M. B.; CLEROUX, A. P.; ROSENBERG, I. N. - Clinical evaluation of corticotropin therapy in children. J. Pediat., 39:392, 1951.

14. KROOP, I. X. A. - Treatment of rheumatic fever with large doses of Cortisone. New York J. Med., 54:2699, 1954.

15. MASSEL, B. F.; WARREN, J. E.; STURGIS, A. P.; HALL, B.; CRAIGE, E. - The clinical response of rheumatic fever and acute carditis to ACTH. New England J. Med., 242:641, 1950.

16. SCHWARTZMAN, J.; ZAONTZ, J. B.; LUBOW, H. - Chorea minor. Preliminary report in six patients treated with combined ACTH and Cortisone. J. Pediat., 43:278, 1953.

17. STOLLERMAN, G. H. - The Prevention of Rheumatic Fever. W. B. Saunders Co., Filadélfia e Londres, 1957, pág. 133.

Clínica Neurológica da Faculdade de Medicina da Universidade de Minas Gerais - Belo Horizonte. Minas Gerais, Brasil.

Trabalho da Clínica Neurológica da Faculdade de Medicina da Universidade de Minas Gerais, apresentado ao I Congresso Latino-Americano de Neurologia, 25 a 28 abril 1957, Buenos Aires, Argentina.

1. AINGER, L. E.; ELY, R. S.; DONE, A. K.; BRILL, A. B.; KELLY, V. C. - a) Sydenham's chorea: Evidence of abnormal adrenal cortex function. Am. J. Dis. Child., 89:575, 1955;
b) Sydenham's chorea: Effects of hormone therapy. Am. J. Dis. Child., 89:580, 1955.
2. ARONSON, N.; DOUGLAS, H. S.; LEWIS, J. M. - Cortisone in Sydenham's chorea: report of 2 cases. J.A.M.A., 145:30, 1951.
3. BLAND, E. F.; JONES, T. D. - The natural history of rheumatic fever: a 20 year perspective. Ann. Int. Med., 37:1006, 1952.
4. BUNIM, J. J. - The clinical effects of Cortisone and ACTH on rheumatic disease. Bull. New York Acad. Med., 27:75, 1951.
5. CUTLER, M. - Cortisone dosage in Sydenham's chorea. J. Med. Soc. New Jersey, 48:226, 1951.
6. DORDICK, J. R.; GLUCK, E. J. - Preliminary clinical trials with Prednisone (Meticorten) in rheumatic diseases: comparative antirheumatic potency, metabolic activity and hormonal properties. J.A.M.A., 158:166, 155.
7. GLASSER, G. H.; MERRIT, H. H. - Effects of Corticotropin (ACTH) and Cortisone on disorders of the nervous system. J.A.M.A., 148:898, 1952.
8. HENCH, P. S.; KENDALL, E. C; SLOCUMB, C. H.; POLLEY, H. F. - Effect of hormone of adrenal cortex (17-hydroxydehydroeorticosterone: compound E) and of pituitary adrenocorticotropin hormone on rheumatoid arthritis. Proc. Staff Meet. Mayo Clin., 24:181, 1949.
9. HENCH, P. S.; SLOCUMB, C. H.; BARNES, A. R.: SMITH, H. L.; POLLEY, H. F.; KENDALL, E. C. - Effects of adrenal cortical hormone 17-hydroxydehydrocorticosterone (compound E) on acute phase of rheumatic fever. Proc. Staff Meet. Mayo Clin., 24:277, 1949.
10. HOLT, K. S.; ILLINGWORTH, R. S.; LORBER, J.; RENDLE-SHORT, J. - Cortisone and salicylates in rheumatic fever. Lancet, 2:1144, 1954.
11. JONES, F. D. - The diagnosis of rheumatic fever. J.A.M.A., 126:481, 1944.
12. KELLY, V. C. - Corticotropin (ACTH) therapy of initial attacks of acute rheumatic fever in children. Am. J. Dis. Child., 84:151, 1952.
13. KREIDBERG, M. B.; CLEROUX, A. P.; ROSENBERG, I. N. - Clinical evaluation of corticotropin therapy in children. J. Pediat., 39:392, 1951.
14. KROOP, I. X. A. - Treatment of rheumatic fever with large doses of Cortisone. New York J. Med., 54:2699, 1954.
15. MASSEL, B. F.; WARREN, J. E.; STURGIS, A. P.; HALL, B.; CRAIGE, E. - The clinical response of rheumatic fever and acute carditis to ACTH. New England J. Med., 242:641, 1950.
16. SCHWARTZMAN, J.; ZAONTZ, J. B.; LUBOW, H. - Chorea minor. Preliminary report in six patients treated with combined ACTH and Cortisone. J. Pediat., 43:278, 1953.
17. STOLLERMAN, G. H. - The Prevention of Rheumatic Fever. W. B. Saunders Co., Filadélfia e Londres, 1957, pág. 133.

Terapêutica hormonal na coréia de Sydenham

Hormonal therapy of Sydenham's chorea

Datas de Publicação

Publicação nesta coleção
20 Fev 2014
Data do Fascículo
Set 1957

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AINGER, L. E.; ELY, R. S.; DONE, A. K.; BRILL, A. B.; KELLY, V. C. - a) Sydenham's chorea: Evidence of abnormal adrenal cortex function. Am. J. Dis. Child., 89:575, 1955;

[2] b) Sydenham's chorea: Effects of hormone therapy. Am. J. Dis. Child., 89:580, 1955.

[3] 2. ARONSON, N.; DOUGLAS, H. S.; LEWIS, J. M. - Cortisone in Sydenham's chorea: report of 2 cases. J.A.M.A., 145:30, 1951.

[4] 3. BLAND, E. F.; JONES, T. D. - The natural history of rheumatic fever: a 20 year perspective. Ann. Int. Med., 37:1006, 1952.

[5] 4. BUNIM, J. J. - The clinical effects of Cortisone and ACTH on rheumatic disease. Bull. New York Acad. Med., 27:75, 1951.

[6] 5. CUTLER, M. - Cortisone dosage in Sydenham's chorea. J. Med. Soc. New Jersey, 48:226, 1951.

[7] 6. DORDICK, J. R.; GLUCK, E. J. - Preliminary clinical trials with Prednisone (Meticorten) in rheumatic diseases: comparative antirheumatic potency, metabolic activity and hormonal properties. J.A.M.A., 158:166, 155.

[8] 7. GLASSER, G. H.; MERRIT, H. H. - Effects of Corticotropin (ACTH) and Cortisone on disorders of the nervous system. J.A.M.A., 148:898, 1952.

[9] 8. HENCH, P. S.; KENDALL, E. C; SLOCUMB, C. H.; POLLEY, H. F. - Effect of hormone of adrenal cortex (17-hydroxydehydroeorticosterone: compound E) and of pituitary adrenocorticotropin hormone on rheumatoid arthritis. Proc. Staff Meet. Mayo Clin., 24:181, 1949.

[10] 9. HENCH, P. S.; SLOCUMB, C. H.; BARNES, A. R.: SMITH, H. L.; POLLEY, H. F.; KENDALL, E. C. - Effects of adrenal cortical hormone 17-hydroxydehydrocorticosterone (compound E) on acute phase of rheumatic fever. Proc. Staff Meet. Mayo Clin., 24:277, 1949.

[11] 10. HOLT, K. S.; ILLINGWORTH, R. S.; LORBER, J.; RENDLE-SHORT, J. - Cortisone and salicylates in rheumatic fever. Lancet, 2:1144, 1954.

[12] 11. JONES, F. D. - The diagnosis of rheumatic fever. J.A.M.A., 126:481, 1944.

[13] 12. KELLY, V. C. - Corticotropin (ACTH) therapy of initial attacks of acute rheumatic fever in children. Am. J. Dis. Child., 84:151, 1952.

[14] 13. KREIDBERG, M. B.; CLEROUX, A. P.; ROSENBERG, I. N. - Clinical evaluation of corticotropin therapy in children. J. Pediat., 39:392, 1951.

[15] 14. KROOP, I. X. A. - Treatment of rheumatic fever with large doses of Cortisone. New York J. Med., 54:2699, 1954.

[16] 15. MASSEL, B. F.; WARREN, J. E.; STURGIS, A. P.; HALL, B.; CRAIGE, E. - The clinical response of rheumatic fever and acute carditis to ACTH. New England J. Med., 242:641, 1950.

[17] 16. SCHWARTZMAN, J.; ZAONTZ, J. B.; LUBOW, H. - Chorea minor. Preliminary report in six patients treated with combined ACTH and Cortisone. J. Pediat., 43:278, 1953.

[18] 17. STOLLERMAN, G. H. - The Prevention of Rheumatic Fever. W. B. Saunders Co., Filadélfia e Londres, 1957, pág. 133.