This study tested the hypothesis that the sexually dimorphic adrenocortical response to stress is already established before birth. Chronically instrumented late gestation pregnant sheep carrying 16 male and 15 female age-matched singleton fetuses were subjected to an acute episode of hypoxic stress. Maternal and fetal blood gases, adrenocorticotrophic hormone (ACTH), and cortisol were measured. In addition, six male and six female fetuses received the ACTH analog, Synacthen, and plasma cortisol was measured. During hypoxic stress, the increment in plasma cortisol was 2-fold greater in male versus females fetuses (30.6 Ïź 3.2 versus 14.3 Ïź 2.0 ng/mL; p Ïœ 0.001) mediated, in part, by greater adrenocortical sensitivity to ACTH. The data support the hypothesis tested and show that sex-specific differences in the cortisol stress response are present before birth with the output of cortisol being much greater in male than in female fetuses. (Pediatr Res 69: 118-122, 2011) D uring threatening situations, the stress system coordinates adaptive responses that adjust homeostatic mechanisms to increase the individual's chance of survival. The hypothalamic-pituitary-adrenal (HPA) axis constitutes one of the main efferent limbs of the stress system, and measurement of circulating plasma adrenocorticotrophic hormone (ACTH) and cortisol concentrations are established measures of the level of psychological, social, and/or physiological stress (1). An adequate capacity for secretion of adrenal glucocorticoids is essential for fetal development and maintenance of an independent life (2,3); the adrenal glands are thus highly perfused with blood and richly innervated. Adrenocortical secretion of glucocorticoids is often used as an example of classical endocrinology, with the principal control provided by the release of ACTH from the distant anterior pituitary and with excess cortisol production switching off the stimulatory signal through negative feedback.It is widely acknowledged that there are differences in the response to stress between the sexes, but the reason underlying these differences is unclear. The literature is often contradictory due, in part, to variations in the type of stress imposed, the particular species being studied, and the age of the subject. For example, in adult rats, females have greater stress responses (4,5); however, in humans, it is young men and old women who show an increased stress response relative to old men and young women (6). In addition, when compared with agematched women, men showed consistently higher plasma cortisol responses to stress in four independent studies (7). It is also accepted that sex hormones can alter the magnitude of the stress response, with androgens being suppressive and estrogens being stimulatory to the HPA axis (8,9) and that manipulation of gonadal steroids soon after birth can have activational and organizational effects on the function of the stress axis later in life (9). Development of the fetal HPA axis is exquisitely controlled and critical for the a...