Corticotrophin‐releasing hormone stimulation tests for the infants with relative adrenal insufficiency. (4th September 2017)

• Record Type: Journal Article
• Authors: Iwanaga, Kougoro; Yamamoto, Akane; Matsukura, Takashi; Niwa, Fusako; Kawai, Masahiko
• Is Part Of: Clinical endocrinology. Volume 87:Number 6(2017)
• Page Start: 660
• Page End: 664
• Publication Date: 2017-09-04
• Subjects: bronchopulmonary dysplasia -- hypotension -- preterm infants -- relative adrenal insufficiency; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.13446
• Languages: English
• ISSNs: 0300-0664

Abstract

Summary: Background: Very low birthweight (VLBW) infants are considered to be vulnerable to relative adrenal insufficiency (RAI); however, diagnosis is difficult in some clinical settings. Considering this background, it is necessary to establish a diagnosis of RAI in preterm infants. Objective: In this study, we attempted to clarify the difference in response to CRH stimulation tests for preterm infants with or without RAI. Methods: Between June 2009 and December 2015, we performed CRH stimulation tests for preterm infants born at a gestational age of <30 weeks at around 2 weeks of age. Retrospectively, subjects were classified into two groups: infants with RAI (n = 9) or without RAI (n = 17) based on the clinical symptoms and responsiveness to hydrocortisone. Results: We found no difference in base or peak serum cortisol levels related to CRH stimulation tests between the two groups; however, delta cortisol levels and responsive ratio (peak‐to‐base ratio) were significantly reduced in infants with RAI. 140 nmol/L for delta cortisol or 1.5 times for peak‐to‐base ratio may be cut‐off levels in preterm infants. Conclusion: This study provides evidence that base cortisol levels of preterm infants with RAI were not different from those without RAI; however, CRH stimulation tests may be a useful tool for the diagnosis of RAI in preterm infants.