Functional Tests of Adrenal Axis in Children with Measurement of Plasma Cortisol by Competitive Protein Binding

Barnes, N. D.; Joseph, Jennifer; Atherden, Shelia M.; Clayton, Barbara E.

doi:10.1136/adc.47.251.66

Cited by 29 publications

(10 citation statements)

References 21 publications

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“…The finding of a much wider variation of basal steroid levels in children than in adults which in all of the 7 steroids studied has been observed particularly during early infancy and childhood is in keeping with the few observations made by other authors on aldosterone (39,42, 52) or cortisol (6). It might be due not only to decreased methodologic sensitivity caused by low levels and small amounts of plasma available, but rather to individual differences in hepatic (7,19,28), and in the case of mineralocorticoids, also renal (15,26) maturation during infancy.…”

Section: Discussionsupporting

confidence: 72%

“…In this species, however, adult values were reached about 1 yr later. In keeping with our findings, no differences with adult levels have been observed in children over 1 yr of age, even when methods not entirely specific for F were used (6,24,40,52).…”

Section: Glucocorticoidssupporting

confidence: 74%

“…It might be due not only to decreased methodologic sensitivity caused by low levels and small amounts of plasma available, but rather to individual differences in hepatic (7,19,28), and in the case of mineralocorticoids, also renal (15,26) maturation during infancy. In addition to the rather scattered basal levels, therefore, plasma steroid levels after adrenal stimulation and/or suppression are needed whenever indicated in order to differentiate clearly between normal and pathologic conditions (6). These tests, however, were ethically not justifiable in the present sample of clinically normal children.…”

Section: Discussionmentioning

confidence: 95%

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Plasma Levels of Aldosterone, Corticosterone, 11-Deoxycorticosterone, Progesterone, 17-Hydroxyprogesterone, Cortisol, and Cortisone During Infancy and Childhood

SIPPELL¹,

DÖRR²,

BIDLINGMAIER³

et al. 1980

Pediatric Research

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Summaryother mineralocorticoids like DOC, and glucocorticoids like B and E exhibit similar patterns in different p&iatric age groups or not. Plasma aldosterone (A), corticosterone (B), deoxycorticoster-~~~~~~l~ published data on the progestins P and 1 7 -0~p with One progesterone ( ' 1,, one exception (23) during the large quantities of blood previously required for their deterthe first weeks of life, then increased significantly reaching adult mination and the sampling difficulties encountered in young levels between v of 'gee Mean progressive'y from 74 children. It prompted us to study these important parameters of after birth to l0 during Yr (' << O.OOO1), then adrenocortical function in a large number of children 'lightly increased to levels-After age yr, ' and 17-OHP, throughout all pediatric age groups using our recently developed in contrast to the other steroids, rose significantly in both boys method for the simultaneous determination of eight plasma steand girls relative to pubertal development.roids by radioimmunoassay (46) requiring only 1-3 ml of periphThe observed changes are thought to be due to (1) adaptation eral blood. of the adrenal neocortex to extrauterine life after disruption of the fetoplacental unit, (2) a physiologic lack of corticosteroid binding globulin (CBC) during infancy due to maturation of hepatic MATERIALS AND METHODS CBG biosynthesis, (3) the functional immaturity of the infant kidney compensated by an increased activity of the renin-angio-A total of 174 infants and (83 boys and 91 girls), aged tensin-aldosterone system, and (4) gradually increasing gonadal * hr-15 yr* were studied' The newborn infants were products secretion of progestins during puberty. of uncomplicated, full term pregnancies and were born by vaginal delivery after labor of spontaneous onset. Infants and children over 2 wk of age were either admitted for minor disorders or for Speculation observation, or were seen at the Outpatient Department and From birth to adulthood, marked evolutional changes were required VenepUnCtUre for diagnostic reasons. In addition, inobserved in the basal plasma concentrations of all physiologically formed consent was obtained from the mothers, fathers, or guardimportant unconjugated corticosteroids and progestins in normal ians. In the two oldest age groups (7-15 yr), there were 26 boys children. Detailed knowledge of the agedependent normal plasma and 26 girls whose pubertal development (53) ranged from Stage steroid pattern reflecting maturational processes of both the hy-1 -4 9 and from Stage 1-59 respectively. Only 5 of these girls were pothalamo-adrenocortical and the hypothalamo-gonadal axis, of after menarche. ,411 subjects included in the present study were the renin-angiotensin-aldosterone system, and of hepatic and renal without evidence of endocrine, renal, circulatory, or any other function, therefore, is a prerequisite for understanding pathologic systemic disease and did not show disturbances of acid base or conditions in pediatric endocrinology.electrolyte metab...

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Section: Discussionsupporting

confidence: 72%

Section: Glucocorticoidssupporting

confidence: 74%

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Plasma Levels of Aldosterone, Corticosterone, 11-Deoxycorticosterone, Progesterone, 17-Hydroxyprogesterone, Cortisol, and Cortisone During Infancy and Childhood

SIPPELL¹,

DÖRR²,

BIDLINGMAIER³

et al. 1980

Pediatric Research

View full text Add to dashboard Cite

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“…cant difference in the response to ACTH whether it was Bven The shortest test in wide use consists of an im or iv injection of alone or in the insulin-ACTH test. All the poststimulation the 1-24 peptide (20,24,38) and determination of plasma cortisol levels showed a positive interindividual correlation with cortisol before and 30 min after the injection (4,11,18,37,39, the basal levels, and all the increments a negative interindividual 41). However, this test is not accurate, and it is used mainly as correlation with the basal levels.…”

Section: Summary Subnormal Basal and Stimulated Levels Thus The Acthmentioning

confidence: 99%

“…Others have combined the minima of the two latter parameters (4,11). Although the increment has been regarded as the most useful parameter of the response (18), we consider it to be of little value.…”

Section: Reference Hypop(tuitarv ~Tmentioning

confidence: 99%

Two-hour Adrenocorticotropic Hormone Test: Accuracy in the Evaluation of the Hypothalamic- Pituitary-Adrenocortical Axis

Leisti

Perheentupa

1978

Pediatr Res

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Summary subnormal basal and stimulated levels. Thus the ACTH test didThe inter-and intraindividual variations of response to an iv not diierentiate this state from ACTH deficiency.bolus of tetracosactide (0.25 mgl1.73 m2) were studied, and a definitive diagnostic 2-hr test was established. The test was Speculation given to 179 subjects: hypopituitary, prednisone-treated nephrotics, patients with the autoimmune polyendocrinopathyWhen the Witeria for a in the 2-hr iv ACTH candidinsis syndrome (APECS), and reference subjects. ~t was test have been carefully established, this test will serve as a repeated in 62 cases and the total of 84 test pairs was analyzed. definitive procedure for the diagnosis and follow-up of states me test was either at 8-9 AM or at 10-11 AM, 2 hr associated with ACTH deficiency, as well as in primary diseases after the injection of insulin for an insulin test. Thirty subjects of the adrenal cortex. Like the other ACTH tests, however, it had both the A~H test and the i n s u l i n -~~~H test. capillary will not diierentiate with certainty between primary and secondblood samples for fluorometric determination of plasma cortisol ary adrenOcOrtical were taken 1 , 2 , and 3 hr after the injection.The distributions of the basal and stimulated levels were positively skewed, and log transformation of the data gaveIn the diagnosis of adrenocortical failure, stimulation with a clearly more appropriate statistics. In most subjects the single dose of exogenous ACTH with determination of the level was highest 2 hr &ter the injection. There was no swifiresponse in plasma cortisol level has partly replaced longer tests. cant difference in the response to ACTH whether it was Bven The shortest test in wide use consists of an im or iv injection of alone or in the insulin-ACTH test. All the poststimulation the 1-24 peptide (20,24,38) and determination of plasma cortisol levels showed a positive interindividual correlation with cortisol before and 30 min after the injection (4, 11, 18, 37, 39, the basal levels, and all the increments a negative interindividual 41). However, this test is not accurate, and it is used mainly as correlation with the basal levels.a screening procedure, with variable criteria for a normal reIn repented tests, the intraindividunl variation in the responses sponse. In none of the 1 to 3-hr tests so far introduced have was &redly correlated with the level of the response, and this criteria for a normal response been adequately established on a correlation could be removed by dividing the intrapair difference theoretically sound basis (23, 3 1-33, 35, 42). We have made a in the values of the parameters by the sum of the values for careful evaluation of a 2-hr ACTH test, which we here propose percentage of intrapair difference (PIPD). m e SD of the for a definitive diagnostic procedure. A preliminary report has distribution of PIPDs was used for an index of precision. The 2-appeared (28). hr cortisol level was substantially more precise than either the basal level or the increment. In an...

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Idiopathic Juvenile Osteoporosis

Teotia¹

1979

Arch Pediatr Adolesc Med

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\s=b\ We describe four children with idiopathic juvenile osteoporosis. All patients were initially seen between the ages of 10 and 13 years and spontaneously recovered following puberty. We review 27 similar cases reported in the literature. Theories on the cause of idiopathic osteoporosis in children are critically discussed. It may be that milder forms remain undiagnosed because of the self-limited course and the pain being confused with a variety of rheumatic disorders. It would be worth observing these cases to determine if they are otherwise prone to development of osteoporosis during pregnancy or in later life.(Am J Dis Child 133: [894][895][896][897][898][899][900] 1979) Idi opathi c juvenile osteoporosis is an uncommon self-limited disease that affects previously healthy chil¬ dren. It starts around the ages of 8 to 14 years and is characterized by arrest of growth, loss of height, joint pain, and varying degrees of generalized osteoporosis with vertebral collapse. The children recover spontaneously during later puberty. Teotia1 reported idiopathic juvenile osteoporosis the first time from India. We describe our further experience with the follow-up of these cases and review 27 similar cases reported in the literature. REPORT OF CASESCase l.-This boy was born in 1956. His prenatal, natal, and postnatal history was noncontributory. He was well and growing normally. He was brought to us in Novem¬ ber 1968 at the age of 12 years with the complaints of low back pain following a 1.8-m fall eight months previously. This constant dull ache was often aggravated by movements of his spine. A detailed dietary evaluation at this stage revealed a daily intake of 2,200 calories, 40 g of protein, 1,022 mg of calcium, and 86 IU of vitamin D. He had a normal appetite. There was no history of nausea, vomiting, recurrent diarrhea, or steatorrhea. There was no history of recent change in weight, altera¬ tion in facial appearance, ankle swelling, muscular weakness, or bleeding tendency. His two brothers (aged 16 and 5 years) and a sister (aged 1 year) were normal. There was no family history of osteogenesis imperfecta or other metabolic bone disor¬ ders.Examination revealed a young boy of average build. His measurements were as follows: height, 127 cm (crown to pubis height, 57.5 cm; pubis to heel height, 69.2 cm), span, 127 cm, and weight, 27.3 kg. Apart from dorsal cyphosis and pigeon chest, no other abnormal findings could be detected on thorough physical examina¬ tion.Results of the following investigations were normal: hemoglobin, total leukocyte count, differential leukocyte count, ESR, electrophoretic strip, serum sodium, serum potassium, serum chloride, serum bilirubin, prothrombin time, urine concentration, and dilution test, and amino acid chromatogram. The plasma calcium value was 9.8 mg/dL; phosphorus, 5.2 mg/dL; alkaline phosphatase, 22 King-Armstrong units/ dL; urinary excretion of calcium, 156 mg/ day; phosphorus excretion, 768 mg/day; 17-ketosteroid excretion, 3.2 mg/day; and 17-ketogenic steroid excretion,...

show abstract

Functional Tests of Adrenal Axis in Children with Measurement of Plasma Cortisol by Competitive Protein Binding

Cited by 29 publications

References 21 publications

Plasma Levels of Aldosterone, Corticosterone, 11-Deoxycorticosterone, Progesterone, 17-Hydroxyprogesterone, Cortisol, and Cortisone During Infancy and Childhood

Plasma Levels of Aldosterone, Corticosterone, 11-Deoxycorticosterone, Progesterone, 17-Hydroxyprogesterone, Cortisol, and Cortisone During Infancy and Childhood

Two-hour Adrenocorticotropic Hormone Test: Accuracy in the Evaluation of the Hypothalamic- Pituitary-Adrenocortical Axis

Idiopathic Juvenile Osteoporosis

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