Document Detail

Suppression and recovery of the neonatal hypothalamic-pituitary-adrenal axis after prolonged dexamethasone therapy.
MedLine Citation:
PMID:  9403653     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the duration and level of hypothalamic-pituitary-adrenal (HPA) axis suppression in premature infants treated with a prolonged course of glucocorticoids for chronic lung disease. STUDY DESIGN: We evaluated HPA axis function in nine very low birth weight (VLBW) infants before and 48 hours after a prolonged (14 to 42 days) dexamethasone (Dex) course. Seven of these infants underwent serial testing in the Clinical Research Center to evaluate the time course of HPA axis recovery. Adrenal function was assessed directly with synthetic adrenocorticotropic hormone (ACTH) stimulation, pituitary function with ovine corticotrophin releasing hormone (oCRH) stimulation, and combined axis function with 3-hour metyrapone testing. RESULTS: Baseline cortisol values were higher before Dex therapy (18.6 +/- 3.9 microg/dl; mean +/- SEM) than after (5.77 +/- 1.45 microg/dl; p < 0.01), as were ACTH-stimulated cortisol levels (24.8 +/- 1.7 microg/dl vs 12.0 +/- 2.2 microg/dl; p < 0.001). ACTH response to oCRH decreased after Dex treatment (22.8 +/- 7.6 pg/ml vs 11.5 +/- pg/ml), but this was not statistically significant (p = 0.18). 11-Deoxycortisol (11-DOC) response to metyrapone dropped from 11.1 +/- 0.5 microg/dl to 4.7 +/- 1.0 microg/dl after Dex therapy (p < 0.0001). Longitudinal testing reveals that adrenal suppression may be short-lived, while recovery of higher centers is more delayed. CONCLUSIONS: Basal cortisol levels may be used as a screening test, but if the level is less than 15 microg/dl, more definitive testing should be performed. The sluggish recovery of higher HPA axis centers is most reliably evaluated by using 11-DOC response to a single dose of metyrapone in VLBW infants after prolonged Dex therapy.
L R Ford; S M Willi; B W Hollis; N M Wright
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  131     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  1997 Nov 
Date Detail:
Created Date:  1998-01-08     Completed Date:  1998-01-08     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  722-6     Citation Subset:  AIM; IM    
Department of Pediatrics, Medical University of South Carolina, Charleston 29425, USA.
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MeSH Terms
Adrenocorticotropic Hormone / diagnostic use
Anti-Inflammatory Agents / adverse effects*
Chronic Disease
Corticotropin-Releasing Hormone / diagnostic use
Dexamethasone / adverse effects*
Gestational Age
Hydrocortisone / blood
Hypothalamo-Hypophyseal System / drug effects*
Infant, Very Low Birth Weight
Longitudinal Studies
Lung Diseases / diagnosis,  drug therapy
Metyrapone / diagnostic use
Pituitary-Adrenal System / drug effects*
Time Factors
Grant Support
Reg. No./Substance:
0/Anti-Inflammatory Agents; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone; 54-36-4/Metyrapone; 9002-60-2/Adrenocorticotropic Hormone; 9015-71-8/Corticotropin-Releasing Hormone

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