Introduction: Over-activity of the hypothalamic-pituitary-adrenal (HPA) axis through a programme set by early growth patterns is hypothesised to lead to central obesity, insulin resistance and hypertension. We therefore examined links between adrenal steroid production and birth weight, rapid early growth, and BMI, blood pressure, waist circumference and resistance to insulin in early childhood through the action of adrenal steroids.

Methods: Timed overnight urine samples were collected in 461 children from a large representative birth cohort. In total 244 boys and 188 girls aged 8.2 to 8.4 years completed the protocol. The excretion rates of individual steroids were measured in order to determine total androgen and cortisol metabolites. Indices of activity of 5-alpha reduction of androgens and cortisol metabolites, and 11-hydroxy steroid dehydrogenase (11HSD) activity were calculated.

Results: In both boys and girls, total urinary androgen and cortisol metabolites were positively related to current height, weight, BMI and waist circumference. Girls had higher urine androgen metabolite levels and 5-androgen indexes than boys, and in girls higher androgen metabolite excretion was associated with lower birth weight and faster postnatal weight gain. After adjustment for current BMI, total cortisol metabolites and 11HSD index were not related to birth weight or postnatal weight gain in either sex.

Conclusions: These data confirm early growth associations in this cohort seen with plasma levels of adrenal androgens at age 8 years, at least in girls. Larger studies and follow-up during puberty are needed to exclude the possibility of programming of cortisol metabolism by early growth.