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Corticotrophin‐releasing hormone stimulation tests for the infants with relative adrenal insufficiency
Author(s) -
Iwanaga Kougoro,
Yamamoto Akane,
Matsukura Takashi,
Niwa Fusako,
Kawai Masahiko
Publication year - 2017
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13446
Subject(s) - medicine , adrenal insufficiency , stimulation , gestational age , hormone , hydrocortisone , endocrinology , corticotropin releasing hormone , pediatrics , pregnancy , genetics , biology
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.