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Programming of the Hypothalamus-Pituitary-Adrenal Axis by Very Preterm Birth

Martijn J J Finken1, Bibian van der Voorn, Jonneke J Hollanders

  • 1Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.

Annals of Nutrition & Metabolism
|March 17, 2017
PubMed

Insights

Very preterm newborns often have impaired stress responses due to hypothalamus-pituitary-adrenal (HPA) axis issues. Later, they may experience increased HPA axis activity, contributing to health problems.

Area of Science:

  • Endocrinology
  • Neonatal Medicine
  • Developmental Pediatrics

Background:

  • Very preterm infants (<32 weeks gestation) exhibit inadequate adrenocortical responses to stress, known as relative adrenal insufficiency.
  • These infants later display signs of heightened glucocorticoid activity, including obesity, insulin resistance, hypertension, and behavioral issues.

Purpose of the Study:

  • To investigate the hypothalamus-pituitary-adrenal (HPA) axis function in very preterm newborns and its long-term implications.
  • To elucidate the mechanisms behind the shift in HPA axis activity from infancy to later childhood.

Main Methods:

  • Review of studies examining HPA axis function in very preterm infants.
  • Analysis of pituitary responsiveness, 11β-hydroxylase activity, and cortisol/cortisone interconversion.
  • Assessment of basal cortisol secretion, adrenal hyperandrogenism, and stress responses later in life.

Main Results:

  • Impairments identified at multiple HPA axis levels in very preterm newborns.
  • Evidence suggests increased basal cortisol secretion and adrenal hyperandrogenism in later life.
  • Despite potential for increased activity, acute stress responses were found to be blunted.

Conclusions:

  • Very preterm newborns possess HPA axis vulnerabilities affecting stress response.
  • These infants are predisposed to heightened HPA axis activity later, potentially explaining their long-term health outcomes.
Abstract

Keywords:
Adrenal insufficiencyCortisolHypercortisolismPreterm birth

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