Plasma 17-hydroxyprogesterone/cortisol ratio is not a predictor of systemic hypotension in extremely premature infants

Aurélie Lacoste, Jean-Benoît Corcuff, Antoine Benard, Sandy Leproust, Fabienne Nacka, Olivier Brissaud, Pascal Barat

CHU de bordeaux, Département de Pédiatrie, Réanimation Pédiatrique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Département de Médecine Nucléaire, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
Département de Pédiatrie, Centre d’Investigation Clinique (CIC 0005), Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Département de Pédiatrie, Endocrinologie Pédiatrique, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
P?le de Santé Publique, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.

DOI: 10.4236/ojped.2013.32015                

Abstract

Background/aims: To determine whether the 17-hydroxyprogesterone (17-OHP)/cortisol ratio as a marker of immature11-beta hydroxylase activity can predict severe systemic hypotension in preterm neonates. Methods: Serum cortisol and 17-OHP concentrations were measured in capillary blood deposited on blotter paper on day 3 post-natal age (Day 3) in infants less than 32 weeks postmenstrual age (PMA). The predictive value of 17-OHP/cortisol ratio for a first episode of systemic hypotension occurring after Day 3 (FESH) was evaluated. Results: Of 105 infants included, 14 patients (13%) presented a FESH. Neither the 17-OHP/cortisol ratio, nor the 17-OHP or cortisol concentrations were associated with the occurrence of a FESH when adjusted for potential confounding factors. 17-OHP and cortisol were inversely associated to PMA (r = ﹣0.36 and ﹣0.40, respectively). Cortisol, but not 17-OHP, was associated with the type of hospitalization unit, the respiratory support and the presence of a patent ductus arteriosus. The 17-OHP/cortisol ratio was associated with the type of hospitalization unit only. Conclusions: The 17-OHP/ cortisol ratio at Day 3 did not predict the occurrence of a first episode of systemic hypotension after Day3 inpreterm neonates.

Keywords

Relative Adrenal Insufficiency; Immaturity; Congenital Adrenal Hyperplasia Screening Program

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Beishuizen, A. and Thijs, L.G. (2001) Relative adrenal failure in intensive care: An identifiable problem requiring treatment? Best Practice & Research: Clinical Endocrinology & Metabolism, 15, 513-531. doi:10.1053/beem. 2001.0167
[2]	Ng, P.C., Lam, C.W., Fok, T.F., Lee, C.H., Ma, K.C., Chan, I.H. and Wong, E. (2001) Refractory hypotension in preterm infants with adrenocortical insufficiency. Archives of Disease in Childhood. Fetal and Neonatal Edition, 84, F122-F124. doi:10.1136/fn.84.2.F122
[3]	Seri, I., Tan, R. and Evans, J. (2001) Cardiovascular effects of hydrocortisone in preterm infants with pressorresistant hypotension. Pediatrics, 107, 1070-1074. doi:10.1542/peds.107.5.1070
[4]	Dasgupta, S.J. and Gill, A.B. (2003) Hypotension in the very low birthweight infant: The old, the new, and the uncertain. Archives of Disease in Childhood. Fetal and Neonatal Edition, 88, F450-F454. doi:10.1136/fn.88.6.F450
[5]	Watkins, A.M., West, C.R. and Cooke, R.W. (1989) Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Human Development, 19, 103-110. doi:10.1016/0378-3782(89)90120-5
[6]	Low, J.A., Froese, A.B., Galbraith, R.S., Smith, J.T., Sauerbrei, E.E. and Derrick, E.J. (1993) The association between preterm newborn hypotension and hypoxemia and outcome during the first year. Acta Paediatrica, 82, 433-437. doi:10.1111/j.1651-2227.1993.tb12717.x
[7]	Hanna, C.E., Keith, L.D., Colasurdo, M.A., Buffkin, D.C., Laird, M.R., Mandel, S.H., Cook, D.M., LaFranchi, S.H. and Reynolds, J.W. (1993) Hypothalamic pituitary adrenal function in the extremely low birth weight infant. The Journal of Clinical Endocrinology & Metabolism, 76, 384-387. doi:10.1210/jc.76.2.384
[8]	Ng, P.C., Lam, C.W., Lee, C.H., Ma, K.C., Fok, T.F., Chan, I.H. and Wong, E. (2002) Reference ranges and factors affecting the human corticotropin-releasing hormone test in preterm, very low birth weight infants. The Journal of Clinical Endocrinology & Metabolism, 87, 4621-4628. doi:10.1210/jc.2001-011620
[9]	Hingre, R.V., Gross, S.J., Hingre, K.S., Mayes, D.M. and Richman, R.A. (1994) Adrenal steroidogenesis in very low birth weight preterm infants. The Journal of Clinical Endocrinology & Metabolism, 78, 266-270. doi:10.1210/jc.78.2.266
[10]	Bolt, R.J., Van Weissenbruch, M.M., Popp-Snijders, C., Sweep, F.G., Lafeber, H.N. and Delemarre-van de Waal, H.A. (2002) Maturity of the adrenal cortex in very preterm infants is related to gestational age. Pediatric Research, 52, 405-410. doi:10.1203/00006450-200209000-00017
[11]	Ng, P.C., Lee, C.H., Lam, C.W., Ma, K.C., Fok, T.F., Chan, I.H. and Wong, E. (2004) Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 89, F119-F126. doi:10.1136/adc.2002.021972
[12]	Watterberg, K.L. and Scott, S.M. (1995) Evidence of early adrenal insufficiency in babies who develop bronchopulmonary dysplasia. Pediatrics, 95, 120-125.
[13]	Watterberg, K.L., Gerdes, J.S., Cole, C.H., Aucott, S.W., Thilo, E.H., Mammel, M.C., Couser, R.J., Garland, J.S., Rozycki, H.J., Leach, C.L., Backstrom, C. and Shaffer, M.L. (2004) Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia: A multicenter trial. Pediatrics, 114, 1649-1657. doi:10.1542/peds.2004-1159
[14]	Nassima, B., Mimouni, S., Ourioux, C., Gatta, B. and Corcuff, J.B. (2007) Capillary blood, an alternative to saliva for the diagnosis of Cushing’s syndrome? Clinica Chimica Acta, 383, 182-183. doi:10.1016/j.cca.2007.04.025
[15]	Nordenstrom, A., Wedell, A., Hagenfeldt, L., Marcus, C. and Larsson, A. (2001) Neonatal screening for congenital adrenal hyperplasia: 17-hydroxyprogesterone levels and CYP21 genotypes in preterm infants. Pediatrics, 108, E68. doi:10.1542/peds.108.4.e68
[16]	Vermes, I., Dohanics, J., Toth, G. and Pongracz, J. (1980) Maturation of the circadian rhythm of the adrenocortical functions in human neonates and infants. Hormone Research, 12, 237-244. doi:10.1159/000179126
[17]	Metzger, D.L., Wright, N.M., Veldhuis, J.D., Rogol, A.D. and Kerrigan, J.R. (1993) Characterization of pulsatile secretion and clearance of plasma cortisol in premature and term neonates using deconvolution analysis. The Journal of Clinical Endocrinology & Metabolism, 77, 458-463. doi:10.1210/jc.77.2.458
[18]	Aucott, S.W., Watterberg, K.L., Shaffer, M.L. and Donohue, P.K. (2008) Do cortisol concentrations predict short-term outcomes in extremely low birth weight infants? Pediatrics, 122, 775-781. doi:10.1542/peds.2007-2252