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Corticotrophin-releasing hormone stimulation tests for the infants with relative adrenal insufficiency

Kougoro Iwanaga1, Akane Yamamoto1, Takashi Matsukura1

  • 1Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Clinical Endocrinology
|August 13, 2017
PubMed

Insights

Diagnosing relative adrenal insufficiency (RAI) in preterm infants is challenging. Corticotropin-releasing hormone (CRH) stimulation tests show reduced cortisol responses in infants with RAI, aiding diagnosis.

Area of Science:

  • Neonatalogy
  • Pediatric Endocrinology

Background:

  • Very low birthweight (VLBW) infants are susceptible to relative adrenal insufficiency (RAI).
  • Diagnosing RAI in preterm infants presents clinical challenges.
  • Establishing reliable diagnostic methods for RAI in preterm neonates is crucial.

Purpose of the Study:

  • To differentiate the response to corticotropin-releasing hormone (CRH) stimulation tests in preterm infants with and without RAI.
  • To identify potential diagnostic markers for RAI in this vulnerable population.

Main Methods:

  • CRH stimulation tests were performed on preterm infants (<30 weeks gestational age) around 2 weeks of age.
  • Infants were retrospectively classified into RAI (n=9) or non-RAI (n=17) groups based on clinical signs and hydrocortisone response.
  • Serum cortisol levels were analyzed at baseline, peak, and calculated for delta and peak-to-base ratios.

Main Results:

  • No significant differences in baseline or peak serum cortisol levels were observed between the RAI and non-RAI groups.
  • Infants with RAI demonstrated significantly reduced delta cortisol levels and peak-to-base ratios compared to controls.
  • Potential cut-off values for diagnosis were suggested: 140 nmol/L for delta cortisol and a 1.5 times peak-to-base ratio.

Conclusions:

  • Baseline cortisol levels do not reliably distinguish preterm infants with RAI from those without.
  • CRH stimulation tests, particularly delta cortisol and peak-to-base ratios, show promise as diagnostic tools for RAI in preterm infants.
  • This study supports the utility of CRH testing for diagnosing RAI in preterm neonates.
Abstract

Keywords:
bronchopulmonary dysplasiahypotensionpreterm infantsrelative adrenal insufficiency

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