Chung Hye Rim
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Pediatr. 2014 Oct;57(10):425-33. doi: 10.3345/kjp.2014.57.10.425. Epub 2014 Oct 31.
Adrenal and thyroid hormones are essential for the regulation of intrauterine homeostasis, and for the timely differentiation and maturation of fetal organs. These hormones play complex roles during fetal life, and are believed to underlie the cellular communication that coordinates maternal-fetal interactions. They serve to modulate the functional adaptation for extrauterine life during the perinatal period. The pathophysiology of systemic vasopressor-resistant hypotension is associated with low levels of circulating cortisol, a result of immaturity of hypothalamic-pituitary-adrenal axis in preterm infants under stress. Over the past few decades, studies in preterm infants have shown abnormal clinical findings that suggest adrenal or thyroid dysfunction, yet the criteria used to diagnose adrenal insufficiency in preterm infants continue to be arbitrary. In addition, although hypothyroidism is frequently observed in extremely low gestational age infants, the benefits of thyroid hormone replacement therapy remain controversial. Screening methods for congenital hypothyroidism or congenital adrenal hyperplasia in the preterm neonate are inconclusive. Thus, further understanding of fetal and perinatal adrenal and thyroid function will provide an insight into the management of adrenal and thyroid function in the preterm infant.
肾上腺和甲状腺激素对于维持子宫内环境稳态以及胎儿器官的及时分化和成熟至关重要。这些激素在胎儿期发挥着复杂的作用，被认为是协调母胎相互作用的细胞通讯基础。它们有助于调节围产期宫外生活的功能适应。系统性血管升压药抵抗性低血压的病理生理学与循环皮质醇水平低有关，这是应激状态下早产儿下丘脑-垂体-肾上腺轴不成熟的结果。在过去几十年中，对早产儿的研究显示出一些异常临床发现，提示肾上腺或甲状腺功能障碍，但用于诊断早产儿肾上腺功能不全的标准仍然是随意的。此外，尽管在极低孕周婴儿中经常观察到甲状腺功能减退，但甲状腺激素替代疗法的益处仍存在争议。早产儿先天性甲状腺功能减退或先天性肾上腺皮质增生的筛查方法尚无定论。因此，进一步了解胎儿和围产期肾上腺及甲状腺功能将有助于深入了解早产儿肾上腺和甲状腺功能的管理。
