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Adrenal and thyroid function in the fetus and preterm infant
1Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Adrenal and thyroid hormones are crucial for fetal development and adaptation to life outside the womb. Understanding their function in preterm infants is key to improving diagnoses and treatments for adrenal and thyroid dysfunction.
Area of Science:
- Endocrinology
- Neonatology
- Fetal Physiology
Background:
- Adrenal and thyroid hormones regulate intrauterine homeostasis and fetal organ maturation.
- These hormones are vital for maternal-fetal communication and adaptation to extrauterine life.
- Immaturity of the hypothalamic-pituitary-adrenal axis in preterm infants can lead to vasopressor-resistant hypotension.
Purpose of the Study:
- To highlight the critical roles of fetal and perinatal adrenal and thyroid function.
- To address the challenges in diagnosing adrenal insufficiency and the controversies in thyroid hormone replacement therapy in preterm infants.
- To emphasize the need for improved understanding to guide clinical management.
Main Methods:
- Review of existing literature on fetal and perinatal adrenal and thyroid function.
- Analysis of clinical findings suggesting adrenal or thyroid dysfunction in preterm infants.
- Discussion of current diagnostic criteria and therapeutic controversies.
Main Results:
- Diagnostic criteria for adrenal insufficiency in preterm infants are often arbitrary.
- Hypothyroidism is common in extremely low gestational age infants, but treatment benefits are debated.
- Screening methods for congenital hypothyroidism and congenital adrenal hyperplasia in preterm neonates are inconclusive.
Conclusions:
- Further research into fetal and perinatal adrenal and thyroid function is essential.
- Improved understanding will enhance the management of adrenal and thyroid disorders in preterm infants.
- Addressing diagnostic and therapeutic uncertainties is critical for improving outcomes.
Abstract:
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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