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Hypothalamic pituitary adrenal function in the extremely low birth weight infant.
J Clin Endocrinol Metab. 1993 Feb; 76(2):384-7.JC

Abstract

Extremely premature infants manifest clinical features suggestive of adrenal insufficiency. Yet, serum cortisol levels are similar in ill and well preterm infants in a setting where one would expect high stress levels in the ill infants. We investigated the hypothalamic-pituitary-adrenal axis in 17 extremely low birth weight stressed premature infants, mean birth weight 739 g, gestational age, 26.1 weeks, using ovine CRH (oCRH) and ACTH stimulation. oCRH (1 microgram/kg) was administered at 2-7 days of life (mean = 4.1). ACTH rose from a basal value 6.0 +/- 0.8 pmol/L (mean +/- SEM) to 9.6 +/- 1.8 pmol/L (P < 0.01) at 15 min and 9.5 +/- 1.7 pmol/L (P < 0.01) at 60 min. Basal cortisol rose from 349.3 +/- 58.1 nmol/L to 422.3 +/- 57.9 nmol/L (P < 0.01) at 15 min and 568.7 +/- 60.2 nmol/L (P < 0.01) at 60 min. Cortisol values remained significantly (P < 0.05) elevated 24 h after oCRH. An ACTH stimulation test performed 24 h after the oCRH test demonstrated a significant cortisol rise from 603.5 +/- 130.5 nmol/L to 882.7 +/- 136.6 nmol/L (P < 0.05) at 60 min. Plasma CRH immunoactivity was also measured before oCRH testing and was detectable in 10 of 15 infants. The mean CRH immunoactivity was 21.8 +/- 4.4 pmol/L in the infants, significantly higher than 8 adult male controls (P < 0.04). Our results show a normal pituitary response to ovine CRH and a normal adrenal response to ACTH. We hypothesize that cortisol levels are inappropriately low in some ill preterm infants because of the inability of the extremely premature brain to recognize the stress of the illness or because of inadequate hypothalamic secretion of CRH. The significance of the measurable plasma CRH in the first week of life is unknown.

Authors+Show Affiliations

Department of Pediatrics, Oregon Health Sciences University, Portland 97201.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

8381799

Citation

Hanna, C E., et al. "Hypothalamic Pituitary Adrenal Function in the Extremely Low Birth Weight Infant." The Journal of Clinical Endocrinology and Metabolism, vol. 76, no. 2, 1993, pp. 384-7.
Hanna CE, Keith LD, Colasurdo MA, et al. Hypothalamic pituitary adrenal function in the extremely low birth weight infant. J Clin Endocrinol Metab. 1993;76(2):384-7.
Hanna, C. E., Keith, L. D., Colasurdo, M. A., Buffkin, D. C., Laird, M. R., Mandel, S. H., Cook, D. M., LaFranchi, S. H., & Reynolds, J. W. (1993). Hypothalamic pituitary adrenal function in the extremely low birth weight infant. The Journal of Clinical Endocrinology and Metabolism, 76(2), 384-7.
Hanna CE, et al. Hypothalamic Pituitary Adrenal Function in the Extremely Low Birth Weight Infant. J Clin Endocrinol Metab. 1993;76(2):384-7. PubMed PMID: 8381799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypothalamic pituitary adrenal function in the extremely low birth weight infant. AU - Hanna,C E, AU - Keith,L D, AU - Colasurdo,M A, AU - Buffkin,D C, AU - Laird,M R, AU - Mandel,S H, AU - Cook,D M, AU - LaFranchi,S H, AU - Reynolds,J W, PY - 1993/2/1/pubmed PY - 1993/2/1/medline PY - 1993/2/1/entrez SP - 384 EP - 7 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 76 IS - 2 N2 - Extremely premature infants manifest clinical features suggestive of adrenal insufficiency. Yet, serum cortisol levels are similar in ill and well preterm infants in a setting where one would expect high stress levels in the ill infants. We investigated the hypothalamic-pituitary-adrenal axis in 17 extremely low birth weight stressed premature infants, mean birth weight 739 g, gestational age, 26.1 weeks, using ovine CRH (oCRH) and ACTH stimulation. oCRH (1 microgram/kg) was administered at 2-7 days of life (mean = 4.1). ACTH rose from a basal value 6.0 +/- 0.8 pmol/L (mean +/- SEM) to 9.6 +/- 1.8 pmol/L (P < 0.01) at 15 min and 9.5 +/- 1.7 pmol/L (P < 0.01) at 60 min. Basal cortisol rose from 349.3 +/- 58.1 nmol/L to 422.3 +/- 57.9 nmol/L (P < 0.01) at 15 min and 568.7 +/- 60.2 nmol/L (P < 0.01) at 60 min. Cortisol values remained significantly (P < 0.05) elevated 24 h after oCRH. An ACTH stimulation test performed 24 h after the oCRH test demonstrated a significant cortisol rise from 603.5 +/- 130.5 nmol/L to 882.7 +/- 136.6 nmol/L (P < 0.05) at 60 min. Plasma CRH immunoactivity was also measured before oCRH testing and was detectable in 10 of 15 infants. The mean CRH immunoactivity was 21.8 +/- 4.4 pmol/L in the infants, significantly higher than 8 adult male controls (P < 0.04). Our results show a normal pituitary response to ovine CRH and a normal adrenal response to ACTH. We hypothesize that cortisol levels are inappropriately low in some ill preterm infants because of the inability of the extremely premature brain to recognize the stress of the illness or because of inadequate hypothalamic secretion of CRH. The significance of the measurable plasma CRH in the first week of life is unknown. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/8381799/Hypothalamic_pituitary_adrenal_function_in_the_extremely_low_birth_weight_infant_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jcem.76.2.8381799 DB - PRIME DP - Unbound Medicine ER -