Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

신생아에서의 부신기능 평가와 질환

Evaluation of function and disorders of the adrenal gland in neonates

  • 황일태 (한림대학교 의과대학 소아과학교실)
  • Hwang, Il Tae (Department of Pediatrics, College of Medicine, Hallym University)
  • 투고 : 2007.02.20
  • 심사 : 2007.02.20
  • 발행 : 2007.03.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Majority of sick full term newborns have adequate adrenal cortical function in response to stress. Acutely ill neonates with a basal cortisol level less than $15{\mu}g/dL$ (414 nmol/L) suggest adrenal insufficiency and require function testing of adrenal function. In premature infant, immaturity of hypothalamic-pituitary adrenal axis (HPA axis), may limit the ability to increase cortisol production in response to stress. The response to low dose ACTH and CRH appears to be useful as an additional test of adrenal function. CRH stimulation has been used increasingly in neonates. The ACTH and CRH stimulated cortisol response of more than $17{\mu}g/dL$ (469 nmol/L) indicates a normal response.

키워드

참고문헌

  1. Liggins GC. Fetal lung maturation. Aust N Z J Obstet Gynaecol 1994;34:247-50 https://doi.org/10.1111/j.1479-828X.1994.tb01066.x
  2. Gross I. Regulation of fetal lung maturation. Am J Physiol 1990;259:L337-44
  3. Pepe GJ, Albrecht ED. Regulation of the primate fetal adrenal cortex. Endocr Rev 1990;11:151-76 https://doi.org/10.1210/edrv-11-1-151
  4. Wallance AM, Beesley J, Thomson M, Giles CA. Ross AM, Taylor NF. Adrenal status during the first month of life in mature and premature human infants. J Endocrinol 1987; 112:473-80 https://doi.org/10.1677/joe.0.1120473
  5. Kangarloo H, Diament MJ, Gold RH, Barrett C, Lippe B, Geffner M, et al. Sonography of adrenal glands in neonates and children :changes in appearance with age. J Clin Ultrasound 1986;14:43-7 https://doi.org/10.1002/jcu.1870140109
  6. Hata K, Nagata H, Nishigaki A, Aoki S, Hata T, Murao F, et al. Ultrasonographic evaluation of adrenal involution during antenatal and neonatal periods. Gynecol Obstet Invest 1988; 26:29-32 https://doi.org/10.1159/000293668
  7. Mesiano S, Jaffe RB. Developmental and functional biology of the primate fetal adrenal cortex. Endocr Rev 1997;18: 378-403 https://doi.org/10.1210/er.18.3.378
  8. Carr BR, Parker CR, Porter JC, MacDonald PC, Simpson ER. Regulation of steroid secretion by adrenal tissue of a human anencephalic fetus. J Clin Endocrinol Metab 1980; 50:870-3 https://doi.org/10.1210/jcem-50-5-870
  9. Kraiem Z, Sack J, Brish M. Serum cortisol levels: the first 10 days in full-term and preterm infants. Isr J Med Sci 1985;21:170-2
  10. Wittekind CA, Arnold JD, Leslie GI, Luttrell B, Jones MP. Longitudinal study of plasma ACTH and cortisol in very low birth weight infants in the first 8 weeks of life. Early Hum Dev 1993;33:191-200 https://doi.org/10.1016/0378-3782(93)90145-K
  11. Bolt RJ, van Weissenbruch MM, Lafeber HN, Delemarrevan de Waal HA. Development of the hypothalamic-pituitary-adrenal axis in the fetus and preterm infant. J Pediatr Endocrinol Metab 2002;15:759-69
  12. Spering MA. Pediatric endocrinology. 2nd ed. Philadelphia: WB Saunders Co 2002:385-438
  13. Helbock HJ, Insoft RM, Conte FA. Glucocorticoid-responsive hypotension in extremely low birth weight newborns. Pediatrics 1993;92:715-7
  14. Hingre RV, Gross SJ, Hingre KS, Mayes DM, Richman RA. Adrenal steroidogenesis in very low birth weight preterm infants. J Clin Endocrinol Metab 1994;78:266-70 https://doi.org/10.1210/jc.78.2.266
  15. Watterberg KL, Scott SM. Evidence of early adrenal insufficiency in babies who develop bronchopulmonary dysplasia. Pediatrics 1995;95:120-5
  16. Merz U, Pfaffle R, Peschgens T, Hornchen H. The hypothalamic- pituitary-adrenal axis in preterm infants weighing < or = 1250 g: association with perinatal data and chronic lung disease. Acta Pediatr 1998;87:313-7 https://doi.org/10.1080/08035259850157381
  17. Watterberg KL. Adrenocortical function and dysfunction in the fetus and neonate. Semin Neonatol 2004;9:13-21 https://doi.org/10.1016/j.siny.2003.08.003
  18. Watterberg KL, Gerdes JS, Gifford KL, Lim HM. Prophylaxis against early adrenal insufficiency to prevent chronic lung disease in premature infants. Pediatrics 1999;104:1258-63 https://doi.org/10.1542/peds.104.6.1258
  19. Banks BA, Stouffer N, Cnaan A, Ning Y, Merrill JD, Ballard RA, et al. Association of plasma cortisol and chronic lung disease in preterm infants. Pediatrics 2001;107:494-8 https://doi.org/10.1542/peds.107.3.494
  20. Watterberg KL, Shaffer ML, Garland JS, Thilo EH, Mammel MC, couser RJ, et al. Effect of dose on response to adrenocorticotropin in extremity low birth weight infants. J Clin Endocrinol Metab 2005;90:6380-5 https://doi.org/10.1210/jc.2005-0734
  21. Langer M, Modi BP, Agus M. Adrenal insufficiency in the critically ill neonate and child. Curr Opin Pediatr 2006;18: 448-53 https://doi.org/10.1097/01.mop.0000236397.79580.85
  22. Soliman AT, Taman KH, Rizk MM, Nasr IS, Alrimawy H, Hamido MS. Circulating adrenocorticotropic hormone (ACTH) and cortisol concentrations in normal, appropriate-for-gestational- age newborns versus those with sepsis and respiratory distress: Cortisol response to low-dose and standard-dose ACTH tests. Metabolism 2004;53:209-14 https://doi.org/10.1016/j.metabol.2003.09.005
  23. Karlsson R, Kallio J, Toppari J, Kero P. Timing of peak serum cortisol values in preterm infants in low-dose and the standard ACTH test. Pediatr Res 1999;45:367-9 https://doi.org/10.1203/00006450-199903000-00013
  24. Fernandez E, Schrader R, Watterberg KL. PRevalence of low cortisol values in term and nearterm infants with vasopressor- resistant hypotension. J Perinatol 2005;25:114-8 https://doi.org/10.1038/sj.jp.7211211
  25. Tantivit P, Subramanian N, Garg M, Ramanathan R, deLemos RA. Low serum cortisol in term newborns with refractory hypotension. J Perinatol 1999;19:352-7 https://doi.org/10.1038/sj.jp.7200202
  26. Ng PC, Wong GW, Lam CW, Lee CH, Wong MY, Fok TF, et al. The pituitary-adrenal responses to exogenous human corticotropin releasing hormone in preterm, very low birth weight infants. J Clin Endocrinol Metab 1997;82:797-9 https://doi.org/10.1210/jc.82.3.797
  27. Karlsson R, Kallio J, Irjala K, Ekblad S, Toppari J, Kero P. Adrenocorticotropin and corticotropin-releasing hormone tests in preterm infants. J Clin Endocrinol Metab 2000;85:4592-5 https://doi.org/10.1210/jc.85.12.4592
  28. Oelkers W. Dose response aspects in the clinical assessment of the hypothalamo-pituitary-adrenal axis, and the low-dose adrenocorticotropin test. Eur J Endocrinol 1996;135:27-33 https://doi.org/10.1530/eje.0.1350027
  29. Wilson DM, Baldwin RB, Ariagno RL. A randomized, placebo- controlled trial effects of dexamethasone on hypothalamo-pituitary-adrenal axis in preterm infants. J Pediatr 1988; 113:764-8 https://doi.org/10.1016/S0022-3476(88)80398-6
  30. Tanaka T, Hibi I, Shimizu N, Imura H, Tanaka K, Fukata J, et al. Evaluation of hypothalamo-pituitary-adrenocortical function in children by human corticotropin-releasing hormone test. Endocr J 1993;40:581-9 https://doi.org/10.1507/endocrj.40.581
  31. Perry M, Kaftori JK, Bar-Major JA. Sonography for diagnosis and follow up of neonatal adrenal hemorrhage. J Clin Ultrasound 1981;9:397-401 https://doi.org/10.1002/jcu.1870090708
  32. Moshang T Jr, Rosenfield RL, Bongiovanni AM, Parks JS, Amrhein JA. Familial glucocorticoid insufficiency. J Pediatr 1973;82:821-6 https://doi.org/10.1016/S0022-3476(73)80073-3
  33. Zanaria E, Muscatelli F, Bardoni B, Strom TM, Guioli S, Guo W, et al. An unusual member of the nuclear hormone receptor superfamily responsible for X-linked adrenal hypoplaisa congenita. Nature 1994;372:635-41 https://doi.org/10.1038/372635a0
  34. Ng PC, Wong GW, Lam CW, Lee CH, Wong MY, Fok TF, et al. Pituitary-adrenal response in preterm very low birth weight infants after treatment with antenatal corticosteroids. J Clin Endocrinol Metab 1997;82:3548-52 https://doi.org/10.1210/jc.82.11.3548
  35. Ogilvie CM, Crouch NS, Rumsby G, Creighton SM, Liao LM, Conway GS. Congenital adrenal hyperplaisa in adults: a review of medical, surgical and psychological issues. Clin Endocrinol 2006;64:2-11 https://doi.org/10.1111/j.1365-2265.2005.02410.x