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A Simple Stress Test For The Evaluation of Hypothalamic-Pituitary-Adrenal Axis during the First 6 Months of Life

Departments of Pediatrics and Internal Medicine, University of Patras Medical School Patras, Greece

Address all correspondence and requests for reprints to S. Mantagos, M.D., Department of Pediatrics, University of Patras Medical School, P.O. Box 1045, 261 10 Patras, Greece.

In 33 normal infants, divided into 3 age groups (<1 month, 1–3 months, and 3–6 months) plasma cortisol was measured at 2230, 2300, and 2330 h. Baseline plasma cortisol at 2230 h. was, as expected, low in all infants, with mean ± SEM values of 41 ± 5, 72 ± 14, and 97 ± 17 nmol/L in each group, respectively. Thirty and 60 min after the painful stimulus of the venipuncture, plasma cortisol increased significantly (P < 0.0005), reaching a maximum increase up to 458 ± 50, 392 ± 66, and 455 ± 97 nmol/L in each age group, respectively.

We conclude that in these infants the hypothalamic-pituitary-adrenal axis was functionally intact and responded to the painful stimulus of the venipuncture by a significant increase in plasma cortisol. This test may be used as a simple procedure for the evaluation of the integrity of the hypothalamic-pituitaryadrenal axis without the administration of pharmacological agents. Its usefulness, however, should be validated with patients having a disorder of the system.

Received March 28, 1990.

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