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The Pituitary-Adrenal Responses to Exogenous Human Corticotropin-Releasing Hormone in Preterm, Very Low Birth Weight Infants

Departments of Pediatrics and Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong (C.W.K.L., D.C.F.C.); and the Department of Mathematics, The Hong Kong University of Science and Technology (M.Y.W.), Shatin, New Territories, Hong Kong

Address all correspondence and requests for reprints to: Dr. P. C. Ng, Department of Pediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

To evaluate the pituitary-adrenal reserve and to standardize the methodology of performing the human CRH (hCRH) stimulation test, we performed the hCRH test on 14 preterm (<32 gestational weeks), very low birth weight infants, who did not receive antenatal or postnatal corticosteroid treatment, on days 7 and 14 of life. Blood samples were obtained 0 (baseline), 15, 30, and 60 min after an iv dose of hCRH (1 µg/kg). The plasma ACTH concentration rose from a basal value of 5.7 ± 0.6 pmol/L (mean ± SEM) to 11.9 ± 2.1 pmol/L (P < 0.005), 9.2 ± 1.2 pmol/L (P < 0.005), and 7.7 ± 0.8 pmol/L (P < 0.005) at 15, 30, and 60 min, respectively. The corresponding rises in serum cortisol from a basal concentration of 396 ± 67 nmol/L were 509 ± 71 nmol/L (P < 0.0001), 647 ± 62 nmol/L (P < 0.0001), and 578 ± 60 nmol/L (P < 0.0001). The plasma ACTH concentration consistently peaked early at 15 min, whereas the maximum cortisol response occurred 30 min post-hCRH stimulation. No significant differences were detected between the hCRH tests performed on days 7 and 14 (P > 0.15). Mechanical ventilation, infant gender, and mode of delivery did not significantly influence the hormonal responses (P > 0.25).

We have defined in this study the pattern, the magnitude of the pituitary-adrenal response, and the timing of the peak concentrations of plasma ACTH and serum cortisol in relation to a standard iv dose of hCRH. The hCRH test in very low birth weight infants appears to be safe and reproducible, and produces a pituitary-adrenal response comparable to that seen in older children and adults, indicating that pituitary-adrenal function is mature at these early stages of gestation.

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