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Parturition Itself Is the Basis for Fetal Adrenal Involution

Department of Neonatology (S.B.-D., P.S.), Meyer Children’s Hospital, Haifa 31096, Israel; Division of Endocrinology (N.Z.-L., M.L., Z.H.), Meyer Children’s Hospital, Haifa 31096, Israel; Department of Radiology (M.E.), Rambam Medical Center, Haifa 31096, Israel; Endocrine Laboratory (Z.S.-O.), Rambam Medical Center, Haifa 31096, Israel; and Faculty of Medicine (P.S., Z.H.), Technion-Israel Institute of Technology, Haifa 31096, Israel

Address all correspondence and requests for reprints to: Nehama Zuckerman-Levin, M.D., Pediatric Endocrinology, Meyer Children’s Hospital, POB 9602, Haifa 31096, Israel. E-mail: zuckerln{at}netvision.net.il.

Context: Newborn infants show a postnatal decline in androgen levels as the fetal adrenal glands involute.

Hypothesis: Placental factors up-regulate dehydroepiandrosterone sulfate (DHEA-S) generation. Hence, regardless of age, parturition will result in fetal adrenal involution and decline in DHEA-S levels.

Subjects and Methods: Premature neonates (n = 30) with gestational age 26–35 wk were studied. Adrenal volume by ultrasonography and serum DHEA-S, cortisol, and androstendione levels were followed weekly between d 1 and 28 of life.

Results: Serum DHEA-S was high on d 1 of life, declining rapidly regardless of gestational age during the first week of life (P < 0.001), and serum androstenedione and cortisol levels followed a similar pattern. Androstenedione levels showed a rise as of d 21 of life in boys but not in girls. The adrenals decreased in ultrasonographic volume from d 1 to 14 of life (P < 0.001), regardless of gestational age.

Conclusions: Involution of the adrenal is faster than previously reported and, regardless of gestational age, occurs within the first week of life in terms of hormone secretion and within 2 wk in adrenal size. Involution involves a decline in DHEA-S but also in androstenedione and cortisol secretion, with a change in enzymatic activity. Males and females differ in their androstenedione levels and enzymatic activity. Parturition itself is the basis for fetal adrenal involution, supporting a key role for placental factors in maintaining the fetal adrenal and generating adrenal androgens.

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