cosyntropin and Infant--Premature--Diseases

To investigate if in preterm newborns, an early adrenocorticotropin hormone (ACTH) test can identify possible transient adrenal insufficiency (TAI), using significant hypotension as a clinical marker.. We studied 40 premature newborns born 24 to 29 weeks gestational age (GA) before 8 h of life. Serum cortisol levels were obtained before and 40 min after administration of 1.0 mcg kg(-1) cosyntropin. Inotropes were used to treat hypotension based on clinical assessment following no response to fluid boluses. Functional echocardiogram was used to support the clinical diagnosis of hypotension. The accuracy of the ACTH test was evaluated using receiver operating characteristic (ROC) curve.. Study patients had mean GA of 26.6 weeks and birth weight of 876 g. In all, 30% required inotropes. The area under the ROC curve for the ACTH test was 87%. Using a cutoff of an increase in cortisol below 12% from baseline had 75% sensitivity and 93% specificity for detecting hypotension. This cutoff was associated with bronchopulmonary dysplasia (8/12 vs 7/28, 95% CI: 0.1 to 0.72), but not with other morbidities or death.. An early ACTH test using the above cutoff has high specificity for detecting hypotension, and thus, can serve as a marker for potential TAI in preterm newborns. Future studies should focus on identifying those newborns for which steroid supplementation would be most beneficial.

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Biomarkers; Bronchopulmonary Dysplasia; Cosyntropin; Early Diagnosis; Echocardiography; Female; Humans; Hydrocortisone; Hypotension; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pregnancy; Prospective Studies; ROC Curve; Sensitivity and Specificity

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Cosyntropin; Female; Humans; Hydrocortisone; Hypotension; Infant, Premature, Diseases; Male; Pregnancy

Topics: Cosyntropin; Dexamethasone; Humans; Hydrocortisone; Infant, Newborn; Infant, Premature, Diseases

We describe a premature female infant exposed in utero to danazol during the first trimester of pregnancy. She was first observed in the newborn period with marked degree virilization and clinical findings suggestive of salt-losing congenital adrenal hyperplasia. This was supported by the high plasma levels of 17 alpha-hydroxyprogesterone and adrenocorticotropic hormone and low plasma cortisol level. Levels of testosterone, androstenedione, 11-deoxycortisol, and renin were also elevated. An excessive increase in the levels of 17 alpha-hydroxyprogesterone and 11-deoxycortisol to corticotropin administration associated with impaired increase in plasma cortisol level strongly suggests a partial block in the 21-hydroxylation of 17 alpha-hydroxyprogesterone. However, the high levels of 11-deoxycortisol also suggest a block of the steroid 11 beta-monooxygenase. A year later she was found to have normal basal levels of the adrenal steroids and normal response to corticotropin administration, pointing out the transitory nature of these abnormalities. It may be hypothesized that danazol produced a transitory block of the steroid 21- and 11 beta-monooxygenases in this child.

Topics: Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Androstenedione; Cortodoxone; Cosyntropin; Danazol; Female; Humans; Hydrocortisone; Hydroxyprogesterones; Infant, Newborn; Infant, Premature, Diseases; Maternal-Fetal Exchange; Pregnadienes; Pregnancy; Pregnancy Trimester, First; Renin; Testosterone