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Adrenal steroids synthesis during acute infectious diseases in infants
C A Longui1, E R M Zlochevsky, T A S S Bachega
1Department of Pediatrics, Pediatric Endocrinology Unit, Santa Casa de São Paulo School of Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
Insights
Elevated 17-hydroxyprogesterone (17OHP) in infants during infection may mimic congenital adrenal hyperplasia (CAH). Early glucocorticoid therapy and ACTH testing are suggested for suspected cases.
Area of Science:
- Pediatric endocrinology
- Infectious diseases
Background:
- Elevated plasma 17-hydroxyprogesterone (17OHP) complicates differential diagnosis in infants with septic shock versus adrenal failure.
- Understanding adrenal steroid patterns during infection is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate adrenal steroid profiles, specifically 17OHP and cortisol, in infants experiencing infections of varying severity.
- To determine the correlation between infection severity and specific adrenal steroid levels.
Main Methods:
- Studied 56 infants aged 1-6 months during infectious episodes.
- Measured plasma levels of cortisol, 17OHP, androstenedione, DHEA, DHEA-S, and testosterone.
Main Results:
- Cortisol elevation was observed in 24 infants; one showed low cortisol.
- 41 infants had 17OHP levels above 6.0 nmol/l, with 10 exceeding 30.2 nmol/l.
- Higher 17OHP concentrations correlated positively with increased disease severity.
Conclusions:
- Infectious diseases can cause 17OHP elevations mimicking non-classic congenital adrenal hyperplasia (NC-CAH).
- Consider initiating glucocorticoid therapy if 17OHP elevation is not typical for classic CAH (SL-CAH).
- Perform ACTH testing post-recovery to rule out CAH when 17OHP levels are significantly elevated during infection.
Unlabelled:
An increase in plasma 17OHP found in infants requiring differential diagnosis between septic shock and adrenal failure led us to look for adrenal steroids pattern during infection.
Infants And Methods:
56 infants, 1-6 months old, were studied during infection of different degrees of severity. Plasma cortisol, 17OHP, androstenedione, DHEA, DHEA-S and testosterone were measured.
Results:
24 patients showed an expected cortisol elevation. One child had a low cortisol level. The concentration of 17OHP was above 6.0 nmol/l (200 ng/dl) in 41 patients and above 30.2 nmol/l (1,000 ng/dl) in 10. Higher 17OHP levels and more severe diseases correlated positively.
Conclusions:
During infectious diseases some patients demonstrated not only cortisol elevation but also 17OHP as high as that observed in NC-CAH. We suggest that if 17OHP elevation is not characteristic of SL-CAH, glucocorticoid therapy should be started and an ACTH test should be performed after recovery before ruling out this pathology.