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Effect of intravenous hydrocortisone administration on glucose homeostasis in small for gestational age infants
Insights
Hydrocortisone (H) treatment in small for gestational age (SGA) infants increased plasma glucose and decreased insulin and glucagon levels. L-alanine administration further raised glucose, suggesting H promotes gluconeogenesis and reduces glucose utilization in SGA infants.
Area of Science:
- Neonatology
- Endocrinology
- Metabolic Research
Background:
- Infants small for gestational age (SGA) often experience glucose homeostasis disturbances.
- Hydrocortisone (H) is used to manage certain conditions in neonates, but its precise effects on glucose metabolism in SGA infants require further elucidation.
Purpose of the Study:
- To investigate the impact of intravenous hydrocortisone (H) on glucose homeostasis in infants small for gestational age (SGA).
- To assess the effect of L-alanine administration on glucose levels in H-treated SGA infants.
Main Methods:
- A comparative study involving 14 SGA infants receiving I.V. hydrocortisone (10 mg/kg) and 17 control SGA infants.
- Measurements of plasma glucose, blood pyruvate, plasma insulin, and plasma glucagon were taken at baseline and at intervals after H and L-alanine administration.
Main Results:
- Hydrocortisone administration led to significantly higher plasma glucose levels (4.78 vs. 2.88 mmol/l) and lower levels of blood pyruvate, plasma insulin (6.4 vs. 12 μIU/ml), and plasma glucagon (62.25 vs. 81.6 pmol/l) in SGA infants compared to controls.
- Subsequent intravenous L-alanine injection in H-treated SGA infants caused a significant rise in plasma glucose (from 4.78 to 5.94 mmol/l) without altering insulin or glucagon levels, unlike in controls.
Conclusions:
- Hydrocortisone administration in SGA infants appears to reduce peripheral glucose utilization by lowering insulin levels.
- The observed glucose increase after L-alanine suggests hydrocortisone enhances gluconeogenesis from alanine in SGA infants, even with suppressed insulin and glucagon.
- These findings highlight a potential mechanism for hydrocortisone's effect on glucose metabolism in vulnerable SGA neonates.
Abstract:
The effects of I.V. hydrocortisone (H) (10 mg/kg) on glucose homeostasis were evaluated at 25 to 85 hours of age in 14 infants who were small for gestational age (SGA) in comparison to 17 control SGA infants. Three hours after H administration, higher levels of plasma glucose than in controls were detected (mean +/- S.E.M.): 4.78 +/- 0.2 vs. 2.88 +/- 0.2 mmol/l (p less than 0.01), while lower levels were found for blood pyruvate (38 +/- 7 vs. 89 +/- 12 mumol/l--p less than 0.01), plasma insulin (6.4 +/- 0.5 vs. 12 +/- 0.8 muIU/ml--p less than 0.05) and plasma glucagon (62.25 +/- 6.6 vs. 81.6 +/- 6.6 pmol/l--p less than 0.05). Three hours after H administration, I.V. injection of L-alanine (150 mg/kg) produced a significant rise over baseline of plasma glucose concentration from 4.78 +/- 0.2 to 5.94 +/- 0.2 mmol/l at 50 min (p less than 0.05), whereas no significant change was observed in controls. There was no significant change in plasma glucagon and insulin concentrations after L-alanine injection in either group. These results show that in SGA infants primed with H, the rise of plasma glucose concentration after L-alanine administration is observed with low plasma insulin levels and without stimulation of glucagon secretion. They suggest that H induced a reduced peripheral utilization of glucose by lowering the plasma levels of insulin and a production of glucose from alanine through gluconeogenesis.