Objective: To investigate if the event of late-onset circulatory collapse (LCC) implicated in dysfunction of adrenal steroidgenesis due to impairment of adrenal remodeling in preterm infants.
Methods: Eleven in the patient group (case) with clinical signs compatible with LCC diagnosis (hypotension, oliguria, and hyponatremia) and 11 in the control group (control) matched them for gestational age without such signs. Steroids in serum were separated and purified by HPLC. Then, all samples were analyzed using ELISA or a gas chromatography-mass spectrometry.
Results: Serum levels of sulfoconjugated steroids (pregnenolone sulfate (Preg S), 17-hydroxypregnenolone sulfate (17-OH-Preg S) and dehydroepiandrosterone sulfate (DHEA S)) in case were significantly higher than those in control. However, there was no significant difference of unconjugated steroid levels (Preg, 17-OH-Preg and DHEA) between case and control. To investigate 3β-hydroxysteroid dehydrogenase (3β-HSD) activity, serum concentration ratio (17-OH-progesterone (17-OH-P)/(17-OH-Preg+17-OH-Preg S)) was measured in case and control. The ratio was significantly decreased in Cace compared with control. Preg->P->->cortisol is a major pathway for cortisol synthesis. 3β-HSD catalyzes step Preg->P. Serum concentration of Preg in case (8.7 ng/ml (3.114.1), median and quartiles) was ten-times higher than control (0.8 ng/ml (0.76.1). However, there were no significant differences of serum P and cortisol levels in case (P: 1.1 ng/ml (1.01.5); cortisol: 7.8 μg/dl (3.111.3)) and in control (0.5 ng/ml (0.11.7); 2.5 μg/dl (1.45.5)).
Conclusion: Cause of the event of LCC is at least in part dysfunction of steroidgenesis due to impaired adrenal remodeling.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector
05 - 09 May 2012
European Society of Endocrinology