Kairalla A B
Department of Pediatrics, Wright-Patterson USAF Medical Center, Dayton, Ohio.
Am J Perinatol. 1992 Sep-Nov;9(5-6):428-30. doi: 10.1055/s-2007-999281.
Tests of hypothalamic-pituitary-adrenal axis function were performed on a set of 32-weeks' gestation triplets whose mother received 16 injections of betamethasone over 8 weeks prior to delivery to induce fetal lung maturation. The purpose of these studies was to determine if clinically significant suppression of fetal adrenocortical function occurred as a result of this repeated and prolonged prenatal exposure to glucocorticoids. Serum cortisol levels were measured on cord blood from each patient. Morning serum cortisol and 11-deoxycortisol levels were measured before and after an oral dose of metyrapone given at midnight on day 5. All three infants were clinically well at birth and had no evidence of hyaline membrane disease. Cord blood cortisol levels were low in each infant (1.97 +/- 0.25 micrograms/dl). By day 5, morning cortisol levels had become normal for each infant (10.77 +/- 2.42 micrograms/dl). Following the metyrapone dose, the 11-deoxycortisol levels rose 10- to 20-fold for each infant, indicating normal function of the hypothalamic-pituitary-adrenal axis by day 6. Adrenocortical suppression following multiple courses of prenatal betamethasone appears to be similar in degree and duration to that reported following brief antenatal therapy with this medication. Further studies are needed to confirm these anecdotal observations.
对一组孕32周的三胞胎进行了下丘脑-垂体-肾上腺轴功能测试，他们的母亲在分娩前8周内接受了16次倍他米松注射以促进胎儿肺成熟。这些研究的目的是确定由于产前反复长期暴露于糖皮质激素，是否会发生具有临床意义的胎儿肾上腺皮质功能抑制。测量了每位患者脐血中的血清皮质醇水平。在第5天午夜口服甲吡酮前后，测量了早晨血清皮质醇和11-脱氧皮质醇水平。所有三名婴儿出生时临床状况良好，没有透明膜病的迹象。每个婴儿的脐血皮质醇水平都很低（1.97±0.25微克/分升）。到第5天，每个婴儿的早晨皮质醇水平已恢复正常（10.77±2.42微克/分升）。服用甲吡酮后，每个婴儿的11-脱氧皮质醇水平升高了10至20倍，表明到第6天下丘脑-垂体-肾上腺轴功能正常。产前多次使用倍他米松后的肾上腺皮质抑制在程度和持续时间上似乎与使用该药物进行短期产前治疗后的情况相似。需要进一步研究来证实这些轶事性观察结果。
