Hypothalamic pituitary adrenal function in the extremely low birth weight infant

Cheryl Hanna, L. Donald Keith, Michael A. Colasurdo, Donald C. Buffkin, Mary R. Laird, Scott H. Mandel, David M. Cook, Stephen Lafranchi, John W. Reynolds

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Extremely premature infants manifest clinical features suggestive of adrenal insufficiency. Yet, serum cortisol levels are similar in ill and well preterm infants in a setting where one would expect high stress levels in the ill infants. We investigated the hypothalamic-pituitary-adrenal axis in 17 extremely low birth weight stressed premature infants, mean birth weight 739 g, gestational age, 26.1 weeks, using ovine CRH (oCRH) and ACTH stimulation. oCRH (1 μg/kg) was administered at 2-7 days of life (mean = 4.1). ACTH rose from a basal value 6.0 ± 0.8 pmol/L (mean ± SEM) to 9.6 ± 1.8 pmol/L (P <0.01) at 15 min and 9.5 ± 1.7 pmol/L (P <0.01) at 60 min. Basal cortisol rose from 349.3 ± 58.1 nmol/L to 422.3 ± 57.9 nmol/L (P <0.01) at 15 min and 568.7 ± 60.2 nmol/L (P <0.01) at 60 min. Cortisol values remained significantly (P <0.05) elevated 24 h after oCRH. An ACTH stimulation test performed 24 h after the oCRH test demonstrated a significant cortisol rise from 603.5 ± 130.5 nmol/L to 882.7 ± 136.6 nmol/L (P <0.05) at 60 min. Plasma CRH immunoactivity was also measured before oCRH testing and was detectable in 10 of 15 infants. The mean CRH immunoactivity was 21.8 ± 4.4 pmol/L in the infants, significantly higher than 8 adult male controls (P <0.04). Our results show a normal pituitary response to ovine CRH and a normal adrenal response to ACTH. We hypothesize that cortisol levels are inappropriately low in some ill preterm infants because of the inability of the extremely premature brain to recognize the stress of the illness or because of inadequate hypothalamic secretion of CRH. The significance of the measurable plasma CRH in the first week of life is unknown.

Original languageEnglish (US)
Pages (from-to)384-387
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume76
Issue number2
StatePublished - Feb 1993

Fingerprint

Extremely Low Birth Weight Infant
Hydrocortisone
Sheep
Adrenocorticotropic Hormone
Premature Infants
Plasmas
Extremely Premature Infants
Adrenal Insufficiency
Low Birth Weight Infant
Brain
Birth Weight
Gestational Age
Scanning electron microscopy
Testing
Serum

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Hanna, C., Keith, L. D., Colasurdo, M. A., Buffkin, D. C., Laird, M. R., Mandel, S. H., ... Reynolds, J. W. (1993). Hypothalamic pituitary adrenal function in the extremely low birth weight infant. Journal of Clinical Endocrinology and Metabolism, 76(2), 384-387.

Hypothalamic pituitary adrenal function in the extremely low birth weight infant. / Hanna, Cheryl; Keith, L. Donald; Colasurdo, Michael A.; Buffkin, Donald C.; Laird, Mary R.; Mandel, Scott H.; Cook, David M.; Lafranchi, Stephen; Reynolds, John W.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 76, No. 2, 02.1993, p. 384-387.

Research output: Contribution to journalArticle

Hanna, C, Keith, LD, Colasurdo, MA, Buffkin, DC, Laird, MR, Mandel, SH, Cook, DM, Lafranchi, S & Reynolds, JW 1993, 'Hypothalamic pituitary adrenal function in the extremely low birth weight infant', Journal of Clinical Endocrinology and Metabolism, vol. 76, no. 2, pp. 384-387.
Hanna C, Keith LD, Colasurdo MA, Buffkin DC, Laird MR, Mandel SH et al. Hypothalamic pituitary adrenal function in the extremely low birth weight infant. Journal of Clinical Endocrinology and Metabolism. 1993 Feb;76(2):384-387.
Hanna, Cheryl ; Keith, L. Donald ; Colasurdo, Michael A. ; Buffkin, Donald C. ; Laird, Mary R. ; Mandel, Scott H. ; Cook, David M. ; Lafranchi, Stephen ; Reynolds, John W. / Hypothalamic pituitary adrenal function in the extremely low birth weight infant. In: Journal of Clinical Endocrinology and Metabolism. 1993 ; Vol. 76, No. 2. pp. 384-387.
@article{18c88cfd4e434554ac154c499e4bc3a4,
title = "Hypothalamic pituitary adrenal function in the extremely low birth weight infant",
abstract = "Extremely premature infants manifest clinical features suggestive of adrenal insufficiency. Yet, serum cortisol levels are similar in ill and well preterm infants in a setting where one would expect high stress levels in the ill infants. We investigated the hypothalamic-pituitary-adrenal axis in 17 extremely low birth weight stressed premature infants, mean birth weight 739 g, gestational age, 26.1 weeks, using ovine CRH (oCRH) and ACTH stimulation. oCRH (1 μg/kg) was administered at 2-7 days of life (mean = 4.1). ACTH rose from a basal value 6.0 ± 0.8 pmol/L (mean ± SEM) to 9.6 ± 1.8 pmol/L (P <0.01) at 15 min and 9.5 ± 1.7 pmol/L (P <0.01) at 60 min. Basal cortisol rose from 349.3 ± 58.1 nmol/L to 422.3 ± 57.9 nmol/L (P <0.01) at 15 min and 568.7 ± 60.2 nmol/L (P <0.01) at 60 min. Cortisol values remained significantly (P <0.05) elevated 24 h after oCRH. An ACTH stimulation test performed 24 h after the oCRH test demonstrated a significant cortisol rise from 603.5 ± 130.5 nmol/L to 882.7 ± 136.6 nmol/L (P <0.05) at 60 min. Plasma CRH immunoactivity was also measured before oCRH testing and was detectable in 10 of 15 infants. The mean CRH immunoactivity was 21.8 ± 4.4 pmol/L in the infants, significantly higher than 8 adult male controls (P <0.04). Our results show a normal pituitary response to ovine CRH and a normal adrenal response to ACTH. We hypothesize that cortisol levels are inappropriately low in some ill preterm infants because of the inability of the extremely premature brain to recognize the stress of the illness or because of inadequate hypothalamic secretion of CRH. The significance of the measurable plasma CRH in the first week of life is unknown.",
author = "Cheryl Hanna and Keith, {L. Donald} and Colasurdo, {Michael A.} and Buffkin, {Donald C.} and Laird, {Mary R.} and Mandel, {Scott H.} and Cook, {David M.} and Stephen Lafranchi and Reynolds, {John W.}",
year = "1993",
month = "2",
language = "English (US)",
volume = "76",
pages = "384--387",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "2",

}

TY - JOUR

T1 - Hypothalamic pituitary adrenal function in the extremely low birth weight infant

AU - Hanna, Cheryl

AU - Keith, L. Donald

AU - Colasurdo, Michael A.

AU - Buffkin, Donald C.

AU - Laird, Mary R.

AU - Mandel, Scott H.

AU - Cook, David M.

AU - Lafranchi, Stephen

AU - Reynolds, John W.

PY - 1993/2

Y1 - 1993/2

N2 - Extremely premature infants manifest clinical features suggestive of adrenal insufficiency. Yet, serum cortisol levels are similar in ill and well preterm infants in a setting where one would expect high stress levels in the ill infants. We investigated the hypothalamic-pituitary-adrenal axis in 17 extremely low birth weight stressed premature infants, mean birth weight 739 g, gestational age, 26.1 weeks, using ovine CRH (oCRH) and ACTH stimulation. oCRH (1 μg/kg) was administered at 2-7 days of life (mean = 4.1). ACTH rose from a basal value 6.0 ± 0.8 pmol/L (mean ± SEM) to 9.6 ± 1.8 pmol/L (P <0.01) at 15 min and 9.5 ± 1.7 pmol/L (P <0.01) at 60 min. Basal cortisol rose from 349.3 ± 58.1 nmol/L to 422.3 ± 57.9 nmol/L (P <0.01) at 15 min and 568.7 ± 60.2 nmol/L (P <0.01) at 60 min. Cortisol values remained significantly (P <0.05) elevated 24 h after oCRH. An ACTH stimulation test performed 24 h after the oCRH test demonstrated a significant cortisol rise from 603.5 ± 130.5 nmol/L to 882.7 ± 136.6 nmol/L (P <0.05) at 60 min. Plasma CRH immunoactivity was also measured before oCRH testing and was detectable in 10 of 15 infants. The mean CRH immunoactivity was 21.8 ± 4.4 pmol/L in the infants, significantly higher than 8 adult male controls (P <0.04). Our results show a normal pituitary response to ovine CRH and a normal adrenal response to ACTH. We hypothesize that cortisol levels are inappropriately low in some ill preterm infants because of the inability of the extremely premature brain to recognize the stress of the illness or because of inadequate hypothalamic secretion of CRH. The significance of the measurable plasma CRH in the first week of life is unknown.

AB - Extremely premature infants manifest clinical features suggestive of adrenal insufficiency. Yet, serum cortisol levels are similar in ill and well preterm infants in a setting where one would expect high stress levels in the ill infants. We investigated the hypothalamic-pituitary-adrenal axis in 17 extremely low birth weight stressed premature infants, mean birth weight 739 g, gestational age, 26.1 weeks, using ovine CRH (oCRH) and ACTH stimulation. oCRH (1 μg/kg) was administered at 2-7 days of life (mean = 4.1). ACTH rose from a basal value 6.0 ± 0.8 pmol/L (mean ± SEM) to 9.6 ± 1.8 pmol/L (P <0.01) at 15 min and 9.5 ± 1.7 pmol/L (P <0.01) at 60 min. Basal cortisol rose from 349.3 ± 58.1 nmol/L to 422.3 ± 57.9 nmol/L (P <0.01) at 15 min and 568.7 ± 60.2 nmol/L (P <0.01) at 60 min. Cortisol values remained significantly (P <0.05) elevated 24 h after oCRH. An ACTH stimulation test performed 24 h after the oCRH test demonstrated a significant cortisol rise from 603.5 ± 130.5 nmol/L to 882.7 ± 136.6 nmol/L (P <0.05) at 60 min. Plasma CRH immunoactivity was also measured before oCRH testing and was detectable in 10 of 15 infants. The mean CRH immunoactivity was 21.8 ± 4.4 pmol/L in the infants, significantly higher than 8 adult male controls (P <0.04). Our results show a normal pituitary response to ovine CRH and a normal adrenal response to ACTH. We hypothesize that cortisol levels are inappropriately low in some ill preterm infants because of the inability of the extremely premature brain to recognize the stress of the illness or because of inadequate hypothalamic secretion of CRH. The significance of the measurable plasma CRH in the first week of life is unknown.

UR - http://www.scopus.com/inward/record.url?scp=0027503237&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027503237&partnerID=8YFLogxK

M3 - Article

C2 - 8381799

AN - SCOPUS:0027503237

VL - 76

SP - 384

EP - 387

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 2

ER -