Journal of Clinical Endocrinology & Metabolism, Vol 78, 266-270, Copyright © 1994 by Endocrine Society

ARTICLES

Adrenal steroidogenesis in very low birth weight preterm infants

RV Hingre, SJ Gross, KS Hingre, DM Mayes and RA Richman
Department of Pediatrics, State University of New York Health Science Center, Syracuse 13210.

Adrenal steroidogenesis was evaluated in 25 sick premature infants with a gestational age of less than 30 weeks. ACTH stimulation tests were performed on the fourth day of life using synthetic ACTH (36 micrograms/kg). Considering the stress and degree of illness, preterm newborns had low basal cortisol levels (mean +/- SEM, 207.4 +/- 23.5 nmol/L), and their levels were similar to basal levels reported for healthy full-term newborns (170.7 +/- 26.8 nmol/L; P = 0.31; reference data from Endocrine Sciences, Inc., Calabasas Hills, CA). However, compared to term neonates, preterm infants had markedly elevated basal levels of 17-hydroxypregnenolone (54.3 +/- 11.2 nmol/L), 17- hydroxyprogesterone (19.7 +/- 4.0 nmol/L), and 11-deoxycortisol (19.1 +/- 3.3 nmol/L), which were 7-, 18-, and 8-fold higher, respectively, than values for term infants. The activity of 3 beta-hydroxysteroid dehydrogenase was not significantly reduced in extremely premature neonates (mean basal ratio of 17-hydroxypregnenolone/17- hydroxyprogesterone, 2.9 +/- 0.2; ACTH-stimulated ratio, 6.5 +/- 0.4). In contrast, the mean basal substrate/product ratio of 11-deoxycortisol was markedly elevated in the preterm infants (11.9 +/- 2.2, ratio x 10(- 2) compared to that in the full-term infants (2.1 +/- 0.4, ratio x 10(- 2); P < 0.001). These findings are consistent with decreased activity of 11 beta-hydroxylase (11 beta OH) in preterm infants born at less than 30 weeks gestation. Decreased 11 beta OH activity appears to be more prominent than the deficiency of 3 beta-hydroxysteroid dehydrogenase that has been found in infants with lesser degrees of prematurity, suggesting that 11 beta OH activity may be regulated during fetal development to increase during the latter part of gestation.

This article has been cited by other articles:

				P. Cavarzere, D. Samara-Boustani, I. Flechtner, M. Dechaux, C. Elie, V. Tardy, Y. Morel, and M. Polak Transient hyper-17-hydroxyprogesteronemia: a clinical subgroup of patients diagnosed at neonatal screening for congenital adrenal hyperplasia Eur. J. Endocrinol., August 1, 2009; 161(2): 285 - 292. [Abstract] [Full Text] [PDF]

				M. J. Stark, I. M. R. Wright, and V. L. Clifton Sex-specific alterations in placental 11{beta}-hydroxysteroid dehydrogenase 2 activity and early postnatal clinical course following antenatal betamethasone Am J Physiol Regulatory Integrative Comp Physiol, August 1, 2009; 297(2): R510 - R514. [Abstract] [Full Text] [PDF]

				P. C. Ng Is There a "Normal" Range of Serum Cortisol Concentration for Preterm Infants? Pediatrics, October 1, 2008; 122(4): 873 - 875. [Full Text] [PDF]

				E. D. Bruder, J. J. Lee, E. P. Widmaier, and H. Raff Microarray and real-time PCR analysis of adrenal gland gene expression in the 7-day-old rat: effects of hypoxia from birth Physiol Genomics, April 24, 2007; 29(2): 193 - 200. [Abstract] [Full Text] [PDF]

				S. Ben-David, N. Zuckerman-Levin, M. Epelman, Z. Shen-Orr, M. Levin, P. Sujov, and Z. Hochberg Parturition Itself Is the Basis for Fetal Adrenal Involution J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 93 - 97. [Abstract] [Full Text] [PDF]

				P. C. Ng, C. H. Lee, F. L. Bnur, I. H.S. Chan, A. W.Y. Lee, E. Wong, H. B. Chan, C. W.K. Lam, B. S.C. Lee, and T. F. Fok A Double-Blind, Randomized, Controlled Study of a "Stress Dose" of Hydrocortisone for Rescue Treatment of Refractory Hypotension in Preterm Infants Pediatrics, February 1, 2006; 117(2): 367 - 375. [Abstract] [Full Text] [PDF]

				M. Heckmann, M. F. Hartmann, B. Kampschulte, H. Gack, R.-H. Bodeker, L. Gortner, and S. A. Wudy Cortisol Production Rates in Preterm Infants in Relation to Growth and Illness: A Noninvasive Prospective Study Using Gas Chromatography-Mass Spectrometry J. Clin. Endocrinol. Metab., October 1, 2005; 90(10): 5737 - 5742. [Abstract] [Full Text] [PDF]

				H. J. van der Kamp, C. G. M. Oudshoorn, B. H. Elvers, M. van Baarle, B. J. Otten, J. M. Wit, and P. H. Verkerk Cutoff Levels of 17-{alpha}-Hydroxyprogesterone in Neonatal Screening for Congenital Adrenal Hyperplasia Should Be Based on Gestational Age Rather Than on Birth Weight J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 3904 - 3907. [Abstract] [Full Text] [PDF]

				C. Z. Minutti, J. M. Lacey, M. J. Magera, S. H. Hahn, M. McCann, A. Schulze, D. Cheillan, C. Dorche, D. H. Chace, J. F. Lymp, et al. Steroid Profiling by Tandem Mass Spectrometry Improves the Positive Predictive Value of Newborn Screening for Congenital Adrenal Hyperplasia J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3687 - 3693. [Abstract] [Full Text] [PDF]

				J. M. Lacey, C. Z. Minutti, M. J. Magera, A. L. Tauscher, B. Casetta, M. McCann, J. Lymp, S. H. Hahn, P. Rinaldo, and D. Matern Improved Specificity of Newborn Screening for Congenital Adrenal Hyperplasia by Second-Tier Steroid Profiling Using Tandem Mass Spectrometry Clin. Chem., March 1, 2004; 50(3): 621 - 625. [Abstract] [Full Text] [PDF]

				P C Ng, C H Lee, C W K Lam, K C Ma, T F Fok, I H S Chan, and E Wong Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2004; 89(2): F119 - F126. [Abstract] [Full Text] [PDF]

				P C Ng, C H Lee, C W K Lam, K C Ma, I H S Chan, E Wong, and T F Fok Early pituitary-adrenal response and respiratory outcomes in preterm infants Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2004; 89(2): F127 - F130. [Abstract] [Full Text] [PDF]

				P. C. Ng, C. W. K. Lam, C. H. Lee, K. C. Ma, T. F. Fok, I. H. S. Chan, and E. Wong Reference Ranges and Factors Affecting the Human Corticotropin-Releasing Hormone Test in Preterm, Very Low Birth Weight Infants J. Clin. Endocrinol. Metab., October 1, 2002; 87(10): 4621 - 4628. [Abstract] [Full Text] [PDF]

				F. G. Riepe, P. Mahler, W. G. Sippell, and C.-J. Partsch Longitudinal Study of Plasma Pregnenolone and 17-Hydroxypregnenolone in Full-Term and Preterm Neonates at Birth and during the Early Neonatal Period J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4301 - 4306. [Abstract] [Full Text] [PDF]

				R. J. Bolt, M. M. van Weissenbruch, C. Popp-Snijders, C. G. J. Sweep, H. N. Lafeber, and H. A. Delemarre-van de Waal Fetal Growth and the Function of the Adrenal Cortex in Preterm Infants J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 1194 - 1199. [Abstract] [Full Text] [PDF]

				A. Nordenstrom, A. Wedell, L. Hagenfeldt, C. Marcus, and A. Larsson Neonatal Screening for Congenital Adrenal Hyperplasia: 17-Hydroxyprogesterone Levels and CYP21 Genotypes in Preterm Infants Pediatrics, October 1, 2001; 108(4): e68 - 68. [Abstract] [Full Text] [PDF]

				B. A. Banks, N. Stouffer, A. Cnaan, Y. Ning, J. D. Merrill, R. A. Ballard, P. L. Ballard, and the North American Thyrotropin-Releasing Hormone T Association of Plasma Cortisol and Chronic Lung Disease in Preterm Infants Pediatrics, March 1, 2001; 107(3): 494 - 498. [Abstract] [Full Text]

				P C Ng, C W K Lam, T F Fok, C H Lee, K C Ma, I H S Chan, and E Wong Refractory hypotension in preterm infants with adrenocortical insufficiency Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2001; 84(2): 122F - 124. [Abstract] [Full Text]

				P C Ng The fetal and neonatal hypothalamic-pituitary-adrenal axis Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2000; 82(3): 250F - 254. [Full Text]

				K. L. Watterberg, S. M. Scott, C. Backstrom, K. L. Gifford, and K. L. Cook Links Between Early Adrenal Function and Respiratory Outcome in Preterm Infants: Airway Inflammation and Patent Ductus Arteriosus Pediatrics, February 1, 2000; 105(2): 320 - 324. [Abstract] [Full Text]

				K. L. Watterberg, J. S. Gerdes, K. L. Gifford, and H.-M. Lin Prophylaxis Against Early Adrenal Insufficiency to Prevent Chronic Lung Disease in Premature Infants Pediatrics, December 1, 1999; 104(6): 1258 - 1263. [Abstract] [Full Text]

				N Linder, N Davidovitch, A Kogan, A Barzilai, J Kuint, R Mazkeret, and J Sack Longitudinal measurements of 17alpha -hydroxyprogesterone in premature infants during the first three months of life Arch. Dis. Child. Fetal Neonatal Ed., November 1, 1999; 81(3): 175F - 178. [Abstract] [Full Text]

				P. L. Jett, M. H. Samuels, P. A. McDaniel, G. I. Benda, S. H. LaFranchi, J. W. Reynolds, and C. E. Hanna Variability of Plasma Cortisol Levels in Extremely Low Birth Weight Infants J. Clin. Endocrinol. Metab., September 1, 1997; 82(9): 2921 - 2925. [Abstract] [Full Text] [PDF]