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. 1986 Jan;61(1):57–60. doi: 10.1136/adc.61.1.57

Response to ACTH in the newborn.

S Thomas, J F Murphy, J Dyas, M Ryalls, I A Hughes
PMCID: PMC1777531  PMID: 3006603

Abstract

Adrenocortical function was studied in 52 newborn infants who had been divided into three groups: preterm well, preterm ill, and term ill. Basal plasma 17-hydroxyprogesterone concentrations were significantly increased in both groups of preterm infants. There was no significant difference in basal plasma cortisol concentrations, although they were highest in preterm ill infants. All infants responded to adrenocorticotrophic hormone (ACTH) stimulation (36 micrograms/kg intramuscularly) with a two to three fold increase in the concentration of both steroids. The peak plasma 17-hydroxyprogesterone response was significantly higher in preterm ill infants. A subgroup of five infants, who were highly stressed but had undetectable basal plasma cortisol concentrations, also showed an appropriate response to ACTH. The results provide useful reference data to assess adrenal function in the infant of a mother given glucocorticoids during pregnancy. There is also a change from the pattern of fetal adrenal steroidogenesis soon after birth, which may be affected by exogenous ACTH stimulation. Roughly 10% of stressed newborns failed to synthesise cortisol basally; temporary glucocorticoid replacement for such infants may be appropriate.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnes N. D., Atherden S. M. Diagnosis of congenital adrenal hyperplasia by measurement of plasma 17-hydroxyprogesterone. Arch Dis Child. 1972 Feb;47(251):62–65. doi: 10.1136/adc.47.251.62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barnes N. D., Joseph J. M., Atherden S. M., Clayton B. E. Functional tests of adrenal axis in children with measurement of plasma cortisol by competitive protein binding. Arch Dis Child. 1972 Feb;47(251):66–73. doi: 10.1136/adc.47.251.66. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barnhart B. J., Carlson C. V., Reynolds J. W. Adrenal cortical function in the postmature fetus and newborn infant. Pediatr Res. 1980 Dec;14(12):1367–1369. doi: 10.1203/00006450-198012000-00021. [DOI] [PubMed] [Google Scholar]
  4. Dyas J., Read G. F., Guha-Maulik T., Hughes I. A., Riad-Fahmy D. A rapid assay for 17 alpha OH-progesterone in plasma, saliva and amniotic fluid using a magnetisable solid-phase antiserum. Ann Clin Biochem. 1984 Sep;21(Pt 5):417–424. doi: 10.1177/000456328402100514. [DOI] [PubMed] [Google Scholar]
  5. Fujieda K., Faiman C., Reyes F. I., Winter J. S. The control of steroidogenesis by human fetal adrenal cells in tissue culture. I. Responses to adrenocorticotropin. J Clin Endocrinol Metab. 1981 Jul;53(1):34–38. doi: 10.1210/jcem-53-1-34. [DOI] [PubMed] [Google Scholar]
  6. Graybeal M. L., Fang V. S. Physiological dosing of exogenous ACTH. Acta Endocrinol (Copenh) 1985 Mar;108(3):401–406. doi: 10.1530/acta.0.1080401. [DOI] [PubMed] [Google Scholar]
  7. Gutai J., George R., Koeff S., Bacon G. E. Adrenal response to physical stress and the effect of adrenocorticotropic hormone in newborn infants. J Pediatr. 1972 Oct;81(4):719–725. doi: 10.1016/s0022-3476(72)80092-1. [DOI] [PubMed] [Google Scholar]
  8. Hughes I. A., Riad-Fahmy D., Griffiths K. Plasma 17OH-progesterone concentrations in newborn infants. Arch Dis Child. 1979 May;54(5):347–349. doi: 10.1136/adc.54.5.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Huhtaniemi I., Koivisto M., Pakarinen A., Tuimala R., Kauppila A. Pituitary-adrenal and testicular function in preterm infants after prenatal dexamethasone treatment. Acta Paediatr Scand. 1982 May;71(3):425–429. doi: 10.1111/j.1651-2227.1982.tb09446.x. [DOI] [PubMed] [Google Scholar]
  10. Kehlet H., Binder C. Value of an ACTH test in assessing hypothalamic-pituitary-adrenocortical function in glucocorticoid-treated patients. Br Med J. 1973 Apr 21;2(5859):147–149. doi: 10.1136/bmj.2.5859.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lytras N., Grossman A., Perry L., Tomlin S., Wass J. A., Coy D. H., Schally A. V., Rees L. H., Besser G. M. Corticotrophin releasing factor: responses in normal subjects and patients with disorders of the hypothalamus and pituitary. Clin Endocrinol (Oxf) 1984 Jan;20(1):71–84. doi: 10.1111/j.1365-2265.1984.tb00061.x. [DOI] [PubMed] [Google Scholar]
  12. Murphy J. F., Joyce B. G., Dyas J., Hughes I. A. Plasma 17-hydroxyprogesterone concentrations in ill newborn infants. Arch Dis Child. 1983 Jul;58(7):532–534. doi: 10.1136/adc.58.7.532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. New M. I., Lorenzen F., Lerner A. J., Kohn B., Oberfield S. E., Pollack M. S., Dupont B., Stoner E., Levy D. J., Pang S. Genotyping steroid 21-hydroxylase deficiency: hormonal reference data. J Clin Endocrinol Metab. 1983 Aug;57(2):320–326. doi: 10.1210/jcem-57-2-320. [DOI] [PubMed] [Google Scholar]
  14. Ohrlander S., Gennser G., Nilsson K. O., Eneroth P. ACTH test to neonates after administration of corticosteroids during gestation. Obstet Gynecol. 1977 Jun;49(6):691–694. [PubMed] [Google Scholar]
  15. Pang S., Murphey W., Levine L. S., Spence D. A., Leon A., LaFranchi S., Surve A. S., New M. I. A pilot newborn screening for congenital adrenal hyperplasia in Alaska. J Clin Endocrinol Metab. 1982 Sep;55(3):413–420. doi: 10.1210/jcem-55-3-413. [DOI] [PubMed] [Google Scholar]
  16. Pohjavuori M., Fyhrquist F. Vasopressin, ACTH and neonatal haemodynamics. Acta Paediatr Scand Suppl. 1983;305:79–83. doi: 10.1111/j.1651-2227.1983.tb09865.x. [DOI] [PubMed] [Google Scholar]
  17. Riad-Fahmy D., Read G. F., Gaskell S. J., Dyas J., Hindawi R. A simple, direct radioimmunoassay for plasma cortisol, featuring a 125I radioligand and a solid-phase separation technique. Clin Chem. 1979 May;25(5):665–668. [PubMed] [Google Scholar]
  18. Riordan F. A., Wood P. J., Wakelin K., Betts P., Clayton B. E. Bloodspot 17 alpha-hydroxyprogesterone radioimmunoassay for diagnosis of congenital adrenal hyperplasia and home monitoring of corticosteroid replacement therapy. Lancet. 1984 Mar 31;1(8379):708–711. doi: 10.1016/s0140-6736(84)92223-2. [DOI] [PubMed] [Google Scholar]
  19. Shimozawa K., Saisho S., Saito N., Yata J., Igarashi Y., Hikita Y., Irie M., Okada K. A neonatal mass-screening for congenital adrenal hyperplasia in Japan. Acta Endocrinol (Copenh) 1984 Dec;107(4):513–518. doi: 10.1530/acta.0.1070513. [DOI] [PubMed] [Google Scholar]
  20. Simonian M. H., Gill G. N. Regulation of the fetal human adrenal cortex: effects of adrenocorticotropin on growth and function of monolayer cultures of fetal and definitive zone cells. Endocrinology. 1981 May;108(5):1769–1779. doi: 10.1210/endo-108-5-1769. [DOI] [PubMed] [Google Scholar]
  21. Sippell W. G., Bidlingmaier F., Knorr D. Development of endogenous glucocorticoids, mineralocorticoids and progestins in the human fetal and perinatal period. Influence of antenatal treatment with betamethasone or phenobarbital. Eur J Clin Pharmacol. 1980 Jul;18(1):95–104. doi: 10.1007/BF00561485. [DOI] [PubMed] [Google Scholar]
  22. Sippell W. G., Dörr H. G., Bidlingmaier F., Knorr D. Plasma levels of aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, 17-hydroxyprogesterone, cortisol, and cortisone during infancy and childhood. Pediatr Res. 1980 Jan;14(1):39–46. doi: 10.1203/00006450-198001000-00010. [DOI] [PubMed] [Google Scholar]
  23. Vermes I., Dohanics J., Tóth G., Pongrácz J. Maturation of the circadian rhythm of the adrenocortical functions in human neonates and infants. Horm Res. 1980;12(5):237–244. doi: 10.1159/000179126. [DOI] [PubMed] [Google Scholar]
  24. Youssefnejadian E., David R. Early diagnosis of congenital adrenal hyperplasia by measurement of 17-hydroxyprogesterone. Clin Endocrinol (Oxf) 1975 Jul;4(4):451–454. doi: 10.1111/j.1365-2265.1975.tb01553.x. [DOI] [PubMed] [Google Scholar]

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