Ng P C, Wong G W, Lam C W, Lee C H, Wong M Y, Fok T F, Wong W, Chan D C
Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong.
J Clin Endocrinol Metab. 1997 Mar;82(3):797-9. doi: 10.1210/jcem.82.3.3832.
To evaluate the pituitary-adrenal reserve and to standardize the methodology of performing the human CRH (hCRH) stimulation test, we performed the hCRH test on 14 preterm (< 32 gestational weeks), very low birth weight infants, who did not receive antenatal or postnatal corticosteroid treatment, on days 7 and 14 of life. Blood samples were obtained 0 (baseline), 15, 30, and 60 min after an iv dose of hCRH (1 microgram/kg). The plasma ACTH concentration rose from a basal value of 5.7 +/- 0.6 pmol/L (mean +/- SEM) to 11.9 +/- 2.1 pmol/L (P < 0.005), 9.2 +/- 1.2 pmol/L (P < 0.005), and 7.7 +/- 0.8 pmol/L (P < 0.005) at 15, 30, and 60 min, respectively. The corresponding rises in serum cortisol from a basal concentration of 396 +/- 67 nmol/L were 509 +/- 71 nmol/L (P < 0.0001), 647 +/- 62 nmol/L (P < 0.0001), and 578 +/- 60 nmol/L (P < 0.0001). The plasma ACTH concentration consistently peaked early at 15 min, whereas the maximum cortisol response occurred 30 min post-hCRH stimulation. No significant differences were detected between the hCRH tests performed on days 7 and 14 (P > 0.15). Mechanical ventilation, infant gender, and mode of delivery did not significantly influence the hormonal responses (P > 0.25). We have defined in this study the pattern, the magnitude of the pituitary-adrenal response, and the timing of the peak concentrations of plasma ACTH and serum cortisol in relation to a standard iv dose of hCRH. The hCRH test in very low birth weight infants appears to be safe and reproducible, and produces a pituitary-adrenal response comparable to that seen in older children and adults, indicating that pituitary-adrenal function is mature at these early stages of gestation.
为评估垂体 - 肾上腺储备并规范人促肾上腺皮质激素释放激素(hCRH)刺激试验的方法,我们对14名未接受产前或产后皮质类固醇治疗的早产(孕周<32周)、极低出生体重儿在出生后第7天和第14天进行了hCRH试验。静脉注射hCRH(1微克/千克)后0(基线)、15、30和60分钟采集血样。血浆促肾上腺皮质激素(ACTH)浓度从基础值5.7±0.6皮摩尔/升(均值±标准误)分别在15、30和60分钟时升至11.9±2.1皮摩尔/升(P<0.005)、9.2±1.2皮摩尔/升(P<0.005)和7.7±0.8皮摩尔/升(P<0.005)。血清皮质醇从基础浓度396±67纳摩尔/升相应升高至分别为509±71纳摩尔/升(P<0.0001)、647±62纳摩尔/升(P<0.0001)和578±60纳摩尔/升(P<0.0001)。血浆ACTH浓度始终在15分钟时早期达到峰值,而皮质醇最大反应出现在hCRH刺激后30分钟。在第7天和第14天进行的hCRH试验之间未检测到显著差异(P>0.15)。机械通气、婴儿性别和分娩方式对激素反应无显著影响(P>0.25)。我们在本研究中确定了垂体 - 肾上腺反应的模式、幅度以及与标准静脉注射剂量hCRH相关的血浆ACTH和血清皮质醇峰值浓度的时间。极低出生体重儿的hCRH试验似乎是安全且可重复的,并且产生的垂体 - 肾上腺反应与大龄儿童和成人相似,表明垂体 - 肾上腺功能在妊娠早期这些阶段已成熟。