Serum Concentrations of Adrenal Steroids and Their Precursors as a Measure of Maturity of Adrenocortical Function in Very Premature Newborns

Nykänen, Päivi; Heinonen, Kirsti; Riepe, Felix G.; Sippell, Wolfgang G.; Voutilainen, Raimo

doi:10.1159/000314970

Cited by 18 publications

(8 citation statements)

References 63 publications

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“…The surge in cortisol production is absent in preterm infants during clinical illness36). Although the human fetal adrenal cortex does not express the 3βHSD enzyme prior to 23-week gestation, there is no evidence of significant immaturity in adrenal 3βHSD activity in preterm infants born between 24-28 weeks of gestation37). Blood concentrations of cortisol and other steroid hormones are no lower in preterm infants with late onset adrenal insufficiency than in control preterm infants38).…”

Section: Adrenal Gland Of Preterm Infantsmentioning

confidence: 99%

Adrenal and thyroid function in the fetus and preterm infant

Chung

2014

Korean J Pediatr

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Adrenal and thyroid hormones are essential for the regulation of intrauterine homeostasis, and for the timely differentiation and maturation of fetal organs. These hormones play complex roles during fetal life, and are believed to underlie the cellular communication that coordinates maternal-fetal interactions. They serve to modulate the functional adaptation for extrauterine life during the perinatal period. The pathophysiology of systemic vasopressor-resistant hypotension is associated with low levels of circulating cortisol, a result of immaturity of hypothalamic-pituitary-adrenal axis in preterm infants under stress. Over the past few decades, studies in preterm infants have shown abnormal clinical findings that suggest adrenal or thyroid dysfunction, yet the criteria used to diagnose adrenal insufficiency in preterm infants continue to be arbitrary. In addition, although hypothyroidism is frequently observed in extremely low gestational age infants, the benefits of thyroid hormone replacement therapy remain controversial. Screening methods for congenital hypothyroidism or congenital adrenal hyperplasia in the preterm neonate are inconclusive. Thus, further understanding of fetal and perinatal adrenal and thyroid function will provide an insight into the management of adrenal and thyroid function in the preterm infant.

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Section: Adrenal Gland Of Preterm Infantsmentioning

confidence: 99%

Adrenal and thyroid function in the fetus and preterm infant

Chung

2014

Korean J Pediatr

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“…This is thought to be secondary to the absence of 3-b-hydroxysteroid dehydrogenase enzyme activity until approximately 23 weeks' gestation in combination with suppression of the fetal hypothalamic-pituitary-adrenal (HPA) axis by maternal cortisol. However, Nykanen et al (5) found that there was no evidence of immaturity in 3-b-hydroxysteroid dehydrogenase activity in preterm infants delivered between 24 and 28 weeks of gestation.…”

Section: Adrenal Functionmentioning

confidence: 98%

Relative Adrenal Insufficiency in Premature Infants: State of the Art

et al. 2015

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Hageman, and Littlejohn have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/ device. Educational Gaps1. More long-term neurodevelopmental outcome studies are also necessary to determine the safety of treatment with hydrocortisone therapy. 2. There is reasonable evidence to suggest that relative adrenal insufficiency is a true entity in critically ill premature infants. 3. More research is necessary to further characterize transient vs permanent adrenal insufficiency in premature infants and to help in the decision-making process of which infants to treat with appropriate doses and dosing intervals of hydrocortisone therapy. AbstractManagement of critically ill very low-birth-weight infants with the clinical picture of vasopressor-resistant shock in the neonatal intensive care unit is a complex issue. Once airway and breathing have been stabilized and hypotension has been treated with volume and vasopressors with no improvement, the issue of cardiovascular insufficiency must be addressed. After cultures have been performed and antibiotic therapy started, the question of adrenal insufficiency arises. This article discusses of the development of the hypothalamic-pituitary-adrenal axis during gestation, aspects of what is considered normal function, and the diagnosis and management of the entity of relative adrenal insufficiency in the premature infant.Objectives After completing this article, readers should be able to:1. Understand the state of the art of relative adrenal insufficiency in the premature infant.

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“…Although the human fetal adrenal cortex does not express the 3βHSD enzyme before approximately 23 weeks gestation, pre vious studies have shown no evidence of significant immaturity in adrenal 3βHSD activity in preterm infants between 2428 weeks gestation 19,20) . In contrast, decreased activity of 11βhy droxylase, which converts 11deoxycortisol to cortisol, is pro minent.…”

Section: Adrenocortical Function Of Preterm Infantsmentioning

confidence: 99%

“…In contrast, decreased activity of 11βhy droxylase, which converts 11deoxycortisol to cortisol, is pro minent. Reduced activity of 11βhydroxylase, rather than that of 3βHSD, is thought to explain the inappropriate production of cortisol in the preterm adrenal gland 19,20) (Figure 1).…”

Section: Adrenocortical Function Of Preterm Infantsmentioning

confidence: 99%

Adrenocortical Function in Preterm Infants

Chung

2015

Neonatal Med

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Adrenal hormones are essential for the timely differentiation and maturation of fetal organs and the regulation of intrauterine homeostasis. These hormones play com plex roles during fetal life, and they are believed to provide the cellular communi cation that coordinates maternalfetal interactions. Cortisol serves to modulate functional adaptations for extrauterine life in the perinatal period. Serum cortisol levels of preterm infants are similar to basal levels reported for healthy fullterm neo nates. However, a rise of cortisol production is absent during illness. Compared with a fetus of a similar gestational age, premature maturation of the hypothalamicpi tuitaryadrenal (HPA) axis is suggested in preterm infants; however, the inappropriate cortisol value observed in severe illness is due to immaturity of 11βhydroxylase activity and an immature response of the brain to stress. Cardiovascular instability associated with adrenal insufficiency is more frequent than formerly reported, and replacing glucocorticoids in the treatment of refractory hypotension is effective without an increase in short term adverse consequences. However, the diagnostic criteria and optimal management have not yet been determined. Thus, further understanding of perinatal adrenal function will provide insight into the improved management of preterm infants.

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Serum Concentrations of Adrenal Steroids and Their Precursors as a Measure of Maturity of Adrenocortical Function in Very Premature Newborns

Cited by 18 publications

References 63 publications

Adrenal and thyroid function in the fetus and preterm infant

Adrenal and thyroid function in the fetus and preterm infant

Relative Adrenal Insufficiency in Premature Infants: State of the Art

Adrenocortical Function in Preterm Infants

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