CRH stimulation tests for the infants with relative adrenal insufficiency

Abstract

Background

Very low birth weight (VLBW) infants are considered to be vulnerable to relative adrenal insufficiency (RAI); however, diagnosis is difficult in some clinical settings. Considering this background, it is necessary to establish a diagnosis of RAI in preterm infants.

Objective

In this study, we attempted to clarify the difference in response to CRH stimulation tests for preterm infants with or without RAI.

Methods

Between June 2009 and December 2015, we performed CRH stimulation tests for preterm infants born at a gestational age of <30 weeks at around two weeks of age. Retrospectively, subjects were classified into two groups: infants with RAI (n=9) or without RAI (n=17) based on the clinical symptoms and responsiveness to hydrocortisone.

Results

We found no difference in base or peak serum cortisol levels related to CRH stimulation tests between the two groups; however delta cortisol levels and responsive ratio (peak to base ratio) were significantly reduced in infants with RAI. 140 nmol/L for delta cortisol or 1.5 times for peak to base ratio may be cut off levels in preterm infants.

Conclusion

This study provides evidence that base cortisol levels of preterm infants with RAI were not different from those without RAI; however, CRH stimulation tests may be a useful tool for the diagnosis of RAI in preterm infants.

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