Kurtoğlu Selim, Sarıcı Dilek, Akın Mustafa Ali, Daar Ghaniya, Korkmaz Levent, Memur Şeyma
Erciyes University Faculty of Medicine, Department of Pediatrics Division of Neonatology, Kayseri, Turkey.
J Clin Res Pediatr Endocrinol. 2011;3(3):160-2. doi: 10.4274/jcrpe.v3i3.31.
During pregnancy, steroids are usually used in maternal diseases such as adrenal failure or other autoimmune diseases, e.g. idiopathic thrombocytopenic purpura (ITP), Crohn's disease, systemic lupus erythematosus, dermatomyositis, scleroderma, Addison's disease and hyperemesis gravidarum, HELLP syndrome. Endogenous or exogenousmaternal steroids are metabolized by the placental enzyme 11 beta-hydroxy steroid dehydrogenase type 2. Prednisolone and methylprednisolone are highly sensitive to this enzyme, while dexamethasone and betamethasone are less well metabolized. Steroids which can cross the placental barrier are administered in cases like fetal lupus, congenital adrenal hyperplasia and for enhancement of fetal lung maturation, whereas steroids used in maternal diseases are usually the ones with low affinity to the placenta; however, in case of long-term use or in high doses, placental enzyme saturation occurs and thus, resulting in fetal adrenal suppression. Antenatal steroids can lead to low birth weight, as observed in our patient. Here, we report a case with fetal adrenal suppression due to maternal methylprednisolone use presenting with early hypoglycaemia and late hyponatremia in neonatal period and requiring three-month replacement therapy.
在孕期，类固醇通常用于治疗母体疾病，如肾上腺功能衰竭或其他自身免疫性疾病，例如特发性血小板减少性紫癜（ITP）、克罗恩病、系统性红斑狼疮、皮肌炎、硬皮病、艾迪生病和妊娠剧吐、HELLP综合征。内源性或外源性母体类固醇由胎盘酶2型11β-羟基类固醇脱氢酶代谢。泼尼松龙和甲泼尼龙对该酶高度敏感，而地塞米松和倍他米松代谢较差。能穿过胎盘屏障的类固醇用于治疗胎儿狼疮、先天性肾上腺增生等情况以及促进胎儿肺成熟，而用于母体疾病的类固醇通常对胎盘亲和力较低；然而，长期使用或高剂量使用时，会出现胎盘酶饱和，从而导致胎儿肾上腺抑制。产前使用类固醇可导致低出生体重，正如我们的患者所观察到的。在此，我们报告一例因母体使用甲泼尼龙导致胎儿肾上腺抑制的病例，该病例在新生儿期出现早期低血糖和晚期低钠血症，需要进行为期三个月的替代治疗。
